An improved nerve-sparing radical hysterectomy technique for cervical cancer using the paravesico-vaginal space as a new surgical landmark

// Yuqin Zhang 1, * , Tingyan Shi 1, * , Sheng Yin 1 , Sining Ma 1 , Di Shi 1 , Jun Guan 2, 3 , Libing Xiang 4 , Yang Liu 4 , Yulan Ren 4 , Deyan Tan 5 and Rongyu Zang 1 1 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, Shanghai, China 2 Department of Gynecology, Tumor Bank Ovarian Cancer, European Competence Center for Ovarian Cancer, Campus Virchow Clinic, Charite Medical University of Berlin, Berlin, Germany 3 Nuffield Department of Obstetrics and Gynecology, University of Oxford, Oxford, United Kingdom 4 Department of Gynecologic Oncology, Fudan University Cancer Center, Shanghai, China 5 Department of Anatomy, Shanghai Medical College, Fudan University, Shanghai, China * These authors contributed equally to the work Correspondence to: Rongyu Zang, email: ryzang@yahoo.com Keywords: paravesico-vaginal space, nerve-sparing radical hysterectomy, deep uterine vein, terminal ureter, cervical cancer Received: April 11, 2017 Accepted: June 16, 2017 Published: July 05, 2017 ABSTRACT Bladder dysfunction remains a major postoperative challenge for early stage cervical cancer patients. The present prospective phase 2 trial in patients with stage IB1 and IIA1 cervical cancer follows up on our previous, unpublished work describing a new surgical landmark, the paravesico-vaginal space. We describe a novel nerve-sparing radical hysterectomy (NSRH) approach to treat early stage cervical cancer without compromising local control rate or survival. Between September 2015 and August 2016, 49 patients were enrolled to receive NSRH. The bladder catheter was routinely removed on postoperative day 4. The primary endpoints were rate of postvoid residual urine volume (PVR) ≤ 50 ml and proportion of patients with successful catheter removal (ClinicalTrials.gov Identifier: NCT02562729). Anatomically, from ventral to dorsal, the terminal ureter, deep uterine vein, and cardinal ligament were the three markers of the paravesico-vaginal space. The median operative time was 100 min, and the median blood loss was 200 ml. Thirty-four patients (69.4%) had successful catheter removal on postoperative day 4, and 17 patients (34.7%) had a PVR ≤ 50 ml. Our results suggest that by accessing the paravesico-vaginal space landmark, the bladder branch of the inferior hypogastric plexus can be completely preserved, contributing to greater NSRH efficiency without compromising outcomes for patients with early stage cervical cancer.