Radical hysterectomy: does the type of incision matter?

Our purpose was to evaluate and compare aspects of operative accessibility and perioperative outcome after radical hysterectomy and pelvic lymphadenectomy performed through a vertical, Pfannenstiel, or Maylard abdominal incision.

During an 8-year interval, 236 patients underwent radical hysterectomy and pelvic lymphadenectomy as primary treatment for cervical cancer at the Watson Clinic. Patients were admitted under a standard perioperative protocol, and all procedures were performed by a gynecologic oncologist. All clinical data was recorded prospectively and updated regularly.

Radical hysterectomy and pelvic lymphadenectomy was completed through a vertical (n = 113), Pfannenstiel (n = 78), or Maylard (n = 45) incision. Although lesion size and depth of stromal invasion was not different between incision types, patients with a Pfannenstiel incision were younger (p < 0.001) and weighed less than those with a vertical (p = 0.001) or Maylard (p < 0.025) incision. The Pfannenstiel was associated with a shorter operative time (Pfannenstiel vs Maylard, p < 0.05; Pfannenstiel vs vertical, p < 0.001), less blood loss (Pfannenstiel vs Maylard, p < 0.025; Pfannenstiel vs vertical, p < 0.001), a lower risk of transfusion, and a shorter hospital stay (Pfannenstiel vs Maylard, p < 0.025; Pfannenstiel vs vertical, p < 0.001). These differences persisted when controlled for patient weight and surgical experience. There was no significant difference in the total number of nodes evaluated. No patient had a positive vaginal margin.

Radical hysterectomy and pelvic lymphadenectomy can be safely performed through a vertical, Maylard, or Pfannenstiel incision. In a selected population a Pfannenstiel incision offers the potential benefit of less abdominal wall trauma without compromising surgical exposure or increasing the risk of surgical complications.