Anatomical Highlights During Nerve-Sparing Radical Hysterectomy: A Step-by-Step Educational Video.

Area of Science:

• Gynecologic Oncology
• Surgical Anatomy
• Minimally Invasive Surgery

Background:

• Simple hysterectomy is standard for early-stage, low-risk cervical cancer (≤2 cm).
• Radical hysterectomy remains the standard for cervical cancer >2 cm with non-SHAPE criteria.
• Nerve-sparing radical hysterectomy demands expert knowledge of pelvic neurovascular anatomy to prevent complications like hypogastric nerve injury and excessive bleeding.

Purpose of the Study:

• To describe a detailed eight-step nerve-sparing radical hysterectomy technique.
• To emphasize the importance of anatomical landmarks in achieving a safe and effective procedure.

Main Methods:

• The study outlines an eight-step nerve-sparing radical hysterectomy (Querleu-Morrow classification: type C1).
• Key steps include developing specific pelvic spaces (pararectal, paravesical, rectovaginal, paravaginal), isolating the ureter and hypogastric nerve, and dissecting critical ligaments.
• Specific attention is given to separating the deep uterine vein from the pelvic splanchnic nerve and transecting the uterine branch from the inferior hypogastric plexus.

Main Results:

• The described technique facilitates nerve-sparing radical hysterectomy.
• Precise anatomical dissection is key to avoiding hypogastric nerve injury and minimizing blood loss.
• The procedure is performed laparoscopically in Japan under public health insurance.

Conclusions:

• Surgeons must master precise anatomical landmarks for retroperitoneal avascular space development.
• Each surgical step should be reproducible for consistent outcomes.
• This technique aims to improve safety and efficacy in radical hysterectomy for cervical cancer.