Download PDF
CC BY-NC-ND 4.0 · Surg J (N Y) 2021; 07(S 02): S48-S56
DOI: 10.1055/s-0041-1739119
Precision Surgery in Obstetrics and Gynecology

Nerve-Sparing Radical Hysterectomy Using the Okabayashi–Kobayashi Method

Noriaki Sakuragi
1   Center for Women's Health (Gynecology), Otaru General Hospital, Otaru, Japan
2   Professor Emeritus, Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
,
Masanori Kaneuchi
1   Center for Women's Health (Gynecology), Otaru General Hospital, Otaru, Japan
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Radical hysterectomy (RH) is a standard treatment for early-stage cervical cancer. This surgery extirpates the uterus along with the paracervical tissues, vagina, and the paracolpium to achieve local control. Pelvic lymphadenectomy is a critical component of RH performed for regional control. A clear understanding of pelvic anatomy is critical to safely performing a RH and achieving optimal oncological and functional outcomes. The various surgical steps can damage the pelvic autonomic nerves, and a systematic nerve-sparing technique is used for the preservation of autonomic nerves. There is an intricate vascular network in the lateral paracervix (cardinal ligament) and the pelvic sidewall. We need to comprehend the three-dimensional structure of the vascular and nerve anatomy in the pelvis to perform RH effectively and safely. We can create six spaces around the uterine cervix, including the paravesical spaces, pararectal spaces, a vesicovaginal space, and a rectovaginal space to reveal the target of extirpation. It is critical to find the proper tissue plane separated by the layers of membranous connective tissue (fascia), in order to minimize intraoperative bleeding.

Keywords

fascia - paracervical tissues - paracolpium - tissue plane - traction and counter traction


Publication History

Article published online:
01 December 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Meigs JV. Radical hysterectomy with bilateral pelvic lymph node dissections; a report of 100 patients operated on five or more years ago. Am J Obstet Gynecol 1951; 62 (04) 854-870
    CrossrefPubMedGoogle Scholar
  • 2 Okabayashi H. Radical abdominal hysterectomy for cancer of the cervix uteri. Modification of the Takayama operation. Surg Gynecol Obstet 1921; 33: 335-341
    PubMedGoogle Scholar
  • 3 Latzko W, Schiffmann J. Klinisches und Anatomisches zur Radikaloperation des Gebarmutterkrebses. Zentralbl Gynäkol 1919; 43: 715-719
    PubMedGoogle Scholar
  • 4 Kobayashi T. Abdominal Radical Hysterectomy With Pelvic Lymphadenectomy for Cancer of the Cervix. Tokyo: Nanazando; 1961
    Google Scholar
  • 5 Sakamoto S, Takizawa K. An improved radical hysterectomy with fewer urological complications and with no loss of therapeutic results for invasive cervical cancer. Baillieres Clin Obstet Gynaecol 1988; 2 (04) 953-962
    CrossrefPubMedGoogle Scholar
  • 6 Sakuragi N, Todo Y, Kudo M, Yamamoto R, Sato T. A systematic nerve-sparing radical hysterectomy technique in invasive cervical cancer for preserving postsurgical bladder function. Int J Gynecol Cancer 2005; 15 (02) 389-397
    CrossrefPubMedGoogle Scholar
  • 7 Kaneuchi M. Radical hysterectomy (function-preserving method). In: Sakuragi N. ed. Surgery for Cervical Cancer and Vulvar Cancer. OGS Now No. 5. Tokyo: Medical View Co. Ltd; 2010
    Google Scholar
  • 8 Ohba Y, Todo Y, Kobayashi N. et al. Risk factors for lower-limb lymphedema after surgery for cervical cancer. Int J Clin Oncol 2011; 16 (03) 238-243
    CrossrefPubMedGoogle Scholar
  • 9 Sakuragi N, Satoh C, Takeda N. et al. Incidence and distribution pattern of pelvic and paraaortic lymph node metastasis in patients with Stages IB, IIA, and IIB cervical carcinoma treated with radical hysterectomy. Cancer 1999; 85 (07) 1547-1554
    CrossrefPubMedGoogle Scholar
  • 10 Yamamoto R, Okamoto K, Ebina Y, Shirato H, Sakuragi N, Fujimoto S. Prevention of vaginal shortening following radical hysterectomy. BJOG 2000; 107 (07) 841-845
    CrossrefPubMedGoogle Scholar
  • 11 Sakuragi N, Murakami G, Konno Y, Kaneuchi M, Watari H. Nerve-sparing radical hysterectomy in the precision surgery for cervical cancer. J Gynecol Oncol 2020; 31 (03) e49
    CrossrefPubMedGoogle Scholar
  • 12 Sakuragi N, Kato T, Shimada C. et al. Oncological outcomes after Okabayashi-Kobayashi radical hysterectomy for early and locally advanced cervical cancer. JAMA Netw Open 2020; 3 (05) e204307
    CrossrefPubMedGoogle Scholar
  • 13 Sakuragi N, Kaneuchi M, Kato T. et al. Tailored radical hysterectomy for locally advanced cervical cancer. Int J Gynecol Cancer 2020; 30 (08) 1136-1142
    CrossrefPubMedGoogle Scholar