New classification system of radical hysterectomy: Emphasis on a three-dimensional anatomic template for parametrial resection

ObjectiveThe international acceptance of a universal classification system for radical hysterectomy is one of the important challenges in gynecologic oncology. The recently published classification system by Querleu and Morrow is a relevant proposal that has been well received by the professional community. However, it does not include a description of parametrial resection in three dimensions, which mostly determines post-operative morbidity.MethodsThe intention of this follow-up paper was to further develop the classification system based on the four proposed types of radical hysterectomy (A–D) into a three-dimensional model using standard anatomical landmarks for definition of resection margins in longitudinal and transverse dimensions and demonstrate it on pictures.ResultsResection margins were defined in longitudinal and transverse dimensions for each suggested type of radical hysterectomy on all three parts of the parametria. Besides precise description using stable anatomical landmarks, all resection lines have been shown on intra-operative photographs.ConclusionFour types of radical hysteretomy can be precisely defined on a three-dimensional anatomical template, including nerve sparing procedure. Our paper should contribute to better standardization (including nomenclature) of the radical hysterectomy, enhancing harmonization of clinical practice in gynecological oncology.

Research Highlights
► Precise description of four types of radical hysterectomy on a three-dimensional anatomic template.
► Identification of deep parametrial surgical resection margins on all three types of the parametria.
► Demonstration of all major anatomical landmarks and surgical resection margins on intra-operative photographs.