RESUMEN
STUDY OBJECTIVE: To show the laparoscopic technique to perform type C radical hysterectomy with a nerve-sparing approach and pelvic lymphadenectomy. DESIGN: Educational video with step-by-step explanation of the technique using videos and pictures to highlight the anatomic landmark that guides the procedure. SETTING: The goal of this procedure is to enlarge the resection of the paracervix at the junction with internal iliac vascular system, leaving the neural part of the structure under the deep uterine vein untouched. Type C consists in the resection of the uterosacral ligament at the rectum level and the vesicouterine ligament at the bladder level. The ureter is mobilized completely, and 15 to 20 mm of the vagina from the tumor or cervix is resected. Performing such an enlarged hysterectomy, the preservation of the nerve supply to the bladder is crucial, leading to the creation of the subclasses. Type C1 conserves a nerve-sparing approach remaining above the deep uterine vein, whereas in type C2 a resection beyond this landmark including the neural part of the paracervix is performed. INTERVENTIONS: Total laparoscopic type C1 radical hysterectomy with pelvic lymphadenectomy. CONCLUSION: This video shows the feasibility of type C radical hysterectomy through a minimally invasive approach. The possibility to perform this type of procedure laparoscopically matches with the more conservative approach to cervical cancer, bringing all the advantages of this technique into this field of gynecologic surgery.
Asunto(s)
Cuello del Útero/cirugía , Histerectomía , Laparoscopía , Escisión del Ganglio Linfático/métodos , Neoplasias del Cuello Uterino/cirugía , Cuello del Útero/inervación , Cuello del Útero/patología , Estudios de Factibilidad , Femenino , Humanos , Histerectomía/métodos , Laparoscopía/métodos , Pelvis/inervación , Vejiga Urinaria/inervaciónRESUMEN
Endometriosis is a chronic, multifactorial disease, which can impact significantly on a women's quality of life. It is associated with pelvic pain, dyspareunia and intestinal disorders, and can lead to infertility. The use of laparoscopic surgery in the management of endometriosis is well documented; however, the optimal management of women with deep infiltrating disease remains controversial. This review describes the different surgical strategies for the treatment of endometriosis.
