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New techniques in radical hysterectomy

Zakashansky, Konstantin; Bradley, William H; Nezhat, Farr R

Current Opinion in Obstetrics & Gynecology: February 2008 - Volume 20 - Issue 1 - p 14–19
doi: 10.1097/GCO.0b013e3282f2288a
Gynecologic cancer: Edited by Anne O. Rodriguez

Purpose of review: To review the recent literature regarding modifications of abdominal radical hysterectomy as well as development of new approaches including laparoscopic, vaginal, and robotic radical hysterectomy.

Recent findings: Nerve-sparing radical hysterectomy technique allows for significant reduction in postoperative bladder morbidity. Radical vaginal hysterectomy with laparoscopic lymph node dissection is a well-recognized technique that offers excellent cure rates with absence of abdominal entry as well as reduced postoperative febrile and gastrointestinal morbidity. Total laparoscopic radical hysterectomy is a minimally invasive alternative to a traditional abdominal radical hysterectomy approach that yields comparable safety profile with a significant reduction in blood loss and hospital stay. Robotic surgery is becoming more widely accepted in the management of gynecologic cancers and larger series describing successful treatment of cervical cancer with robotic radical hysterectomy are soon to be published.

Summary: There are a number of approaches to performing radical hysterectomy. The feasibility and safety of these techniques have been well established. Preliminary oncologic outcome data are encouraging. The decision to utilize newer techniques depends on the patient and type of practice, as well as the surgeon's comfort level with laparoscopy, robotics, or vaginal surgery.

Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Medical Center, New York, USA

Correspondence to Konstantin Zakashansky, MD, Assistant Professor of Obstetrics and Gynecology, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Science, The Mount Sinai Medical Center, 1176 Fifth Avenue, Box 1173, New York, NY 10029, USA Tel: +1 212 241 5034; fax: +1 212 987 6386; e-mail: konstantin.zakashansky@mssm.edu

© 2008 Lippincott Williams & Wilkins, Inc.