[Total mesometrial resection: nerve-sparing extended radical abdominal hysterectomy]

The total mesometrial resection (TMMR) is the first radical hysterectomy procedure based on defined anatomical landmarks with all surgical steps. The new abdominal operation combines maximum resection of the oncologically relevant mesometrium with minimal tissue traumatization and sparing of the pelvic autonomic nervous system. The extended pelvic and low periaortic lymph node dissection which is part of the procedure includes the removal of the lymphatic tissue localized laterally and dorsally of the main vessels. A prospective multidimensional trial is currently under way to evaluate the potential of the total mesometrial resection to improve the therapeutic index in the surgical treatment of carcinoma of the uterine cervix, especially for high risk tumors.