Robotic nerve-sparing radical hysterectomy: Feasibility and technique

ObjectiveTo describe the anatomy of pelvic autonomic nerves as it applies to nerve-sparing radical hysterectomy, and the technique, feasibility, and results of robotic nerve-sparing radical hysterectomy.MethodsProspective evaluation of 6 patients undergoing robotic nerve-sparing radical hysterectomy (type C1) for cervical cancer Stage IB (1B1 in 3 and 1B2 in 3 patients). Pelvic lymphadenectomy was performed in 3 patients and pelvic and aortic in the remaining 3 patients.ResultsThe operation was completed in all patients. The mean age of the patients was 51.0 (range 33–73) and mean BMI 27.8 (range 23.2–35.1). The mean operating time was 238.6 min (range 207–256), mean blood loss 135 ml (range 100–150), mean number of lymph nodes was 23.6 (range 19–29), mean hospital stay was 2 days (range 1–4). There were no intraoperative complications. Postoperative complications occurred in 1 patient with an ileus who required an extended hospital stay. One patient did not regain normal urinary voidings until the fourth week after surgery. All patients remain free of disease.ConclusionRobotic nerve-sparing radical hysterectomy is safe and feasible. Urinary dysfunction may occur.

Research Highlights
► The anatomy of pelvic autonomic nerves was studied in cadavers as it applies to radical hysterectomy.
► Robotic nerve sparing radical hysterectomy was performed in 6 patients and found safe and feasible.
► The nerve sparing technique reduces but does not eliminate bladder dysfunction.