Radical Hysterectomy: A Focus on Querleu-Morrow Type B

The recently published SHAPE trial¹ may limit the exposure of trainees to modified radical hysterectomy, Querleu-Morrow type B². It is therefore timely to reestablish a simple description of the technique with an educational video.

The steps of the Type B1 (modified radical hysterectomy) (Fig. 1) are as follows: step 1: preparation of lateral, ventral, and dorsal spaces (three steps); step 2: management of the uterine artery and of the parauterine lymphovascular tissue; step 3: unroofing of the ureter, division of the vesicouterine ligaments, and mobilization of the bladder base; step 4: division of the rectovaginal ligaments; and step 5: division of the paracervix at the ureter.

The B2 variant, characterized by adding a lateral paracervical lymph node dissection, and the recently described parauterine lymphovascular tissue (PULT)^3,4 resection, will be also featured. Here are the steps for additional paracervical lymphadenectomy: step 1: separation from the obturator nerve; step 2: separation from the paravesical tissue; step 3: removing the ventral component of the paracervix (lateral "parametrium"); step 4: removing the dorsal component of the paracervix (internal iliac nodes); and step 5: removing the lateral component of the paracervix (presciatic nodes).

In this video, we analyzed the surgical technique for type B radical hysterectomy, focusing on dissection of the uterus and lymph nodes, including the PULT. This highlights the importance of maintaining standardization of the procedure throughout the generations of gynecologic oncologists.