Step-by-step Type C Laparoscopic Radical Hysterectomy

With Nerve-sparing Approach

Gabriele Centini, MD*, Karolina Afors, MD, Rouba Murtada, MD, Jesus Castellano, MD,
Lucia Lazzeri, MD, Rodrigo Fernandes, MD, and Arnoud Wattiez, MD
From the Department of Developmental Medicine, University of Siena, Siena, Italy (Drs. Centini and Lazzeri), IRCAD France, Strasbourg,
France (Dr. Centini), and Hospital Santa Maria alle Scotte, Siena, Italy (Drs. Afors, Murtada, Castellano, Fernandes, and Wattiez).

ABSTRACT Study Objective: To show the laparoscopic technique to perform type C radical hysterectomy with a nerve-sparing approach
and pelvic lymphadenectomy.
Design: Educational video with step-by-step explanation of the technique using videos and pictures to highlight the anatomic
landmark that guides the procedure.
Setting: The goal of this procedure is to enlarge the resection of the paracervix at the junction with internal iliac vascular
system, leaving the neural part of the structure under the deep uterine vein untouched. Type C consists in the resection of
the uterosacral ligament at the rectum level and the vesicouterine ligament at the bladder level. The ureter is mobilized
completely, and 15 to 20 mm of the vagina from the tumor or cervix is resected. Performing such an enlarged hysterectomy,
the preservation of the nerve supply to the bladder is crucial, leading to the creation of the subclasses. Type C1 conserves a
nerve-sparing approach remaining above the deep uterine vein, whereas in type C2 a resection beyond this landmark including
the neural part of the paracervix is performed.
Interventions: Total laparoscopic type C1 radical hysterectomy with pelvic lymphadenectomy.
Conclusion: This video shows the feasibility of type C radical hysterectomy through a minimally invasive approach. The
possibility to perform this type of procedure laparoscopically matches with the more conservative approach to cervical cancer,
bringing all the advantages of this technique into this field of gynecologic surgery. Journal of Minimally Invasive Gynecology
(2015) 22, 545 Ó 2015 AAGL. All rights reserved.
Keywords: Laparoscopy; Nerve sparing; Radical hysterectomy
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Supplementary Data
Supplementary data related to this article can be found at
http://dx.doi.org/10.1016/j.jmig.2015.02.010.

The authors declare no conflict of interest. Submitted February 4, 2015. Accepted for publication February 15, 2015.
Corresponding author: Gabriele Centini, MD, Department of Develop- Available at www.sciencedirect.com and www.jmig.org
mental Medicine, University of Siena, Viale Bracci 16, Siena, Tus-
cany 53100.
E-mail: centini.gabriele@gmail.com

1553-4650/$ - see front matter Ó 2015 AAGL. All rights reserved.

http://dx.doi.org/10.1016/j.jmig.2015.02.010