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Benefit of robot-assisted laparoscopy in nerve-sparing radical hysterectomy: urinary morbidity in early cervical cancer



To evaluate the feasibility of nerve-sparing radical hysterectomy in early cervical cancer by robot-assisted laparoscopy and atonic bladder rate.


This was a retrospective study with consecutive patients in three gynecological oncology departments. Patients with <2 cm cervical cancer had nerve-sparing radical hysterectomy by robot-assisted laparoscopy and pelvic lymphadenectomy. Two days after surgery, we systematically removed the Foley bladder catheter.


The median (range) age and body mass index of the 30 patients were 44 (33–68) years and 23.9 (17.7–39.4) kg/m2, respectively. The median (range) tumor diameter at the time of surgery was 13 (4–38) mm. The median (range) operative time, blood loss, and number of pelvic lymph nodes (any common iliac lymph nodes) were 305 (180–405) min, 100 (30–1,500) ml, and 18 (7–28). The overall complication rate was 52.3 %, of which 6.7 % atonic bladder. Twenty-eight patients (93.3 %) were discharged 2 days after surgery with spontaneous voiding and no residual urine >100 ml.


Nerve-sparing radical hysterectomy by robot-assisted laparoscopy is feasible in early cervical cancer (<2 cm). A total of 93.3 % of the patients were discharged 2 days after surgery with spontaneous voiding. The next step would be a prospective study with objective urodynamic investigations.

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  1. 1.

    Bergmark K, Avall-Lundqvist E, Dickman PW, Henningsohn L, Steineck G (2006) Lymphedema and bladder-emptying difficulties after radical hysterectomy for early cervical cancer and among population controls. Int J Gynecol Cancer 16:1130–1139

  2. 2.

    Sakuragi N, Todo Y, Kudo M, Yamamoto R, Sato T (2005) A systematic nerve-sparing radical hysterectomy technique in invasive cervical cancer for preserving postsurgical bladder function. Int J Gynecol Cancer 15:389–397

  3. 3.

    Yabuki Y, Akihiro A, Hoshiba T, Nishimoto H, Satou N (1996) A new proposal for radical hysterectomy. Gynecol Oncol 62:370–378

  4. 4.

    Hockel M, Konerding MA, Heussel CP (1998) Liposuction-assisted nerve-sparing extended radical hysterectomy: oncologic rationale, surgical anatomy, and feasibility study. Am J Obstet Gynecol 178:971–976

  5. 5.

    Possover M, Stober S, Plaul K, Schneider A (2000) Identification and preservation of the motoric innervation of the bladder in radical hysterectomy type III. Gynecol Oncol 79:154–157

  6. 6.

    Trimbos JB, Maas CP, Deruiter MC, Peters AA, Kenter GG (2001) A nerve-sparing radical hysterectomy: guidelines and feasibility in western patients. Int J Gynecol Cancer 11:180–186

  7. 7.

    Raspagliesi F, Ditto A, Fontanelli R, Solima E, Hanozet F, Zanaboni F, Kusamura S (2004) Nerve-sparing radical hysterectomy: a surgical technique for preserving the autonomic hypogastric nerve. Gynecol Oncol 93:307–314

  8. 8.

    Marchal F, Rauch P, Vandromme J, Laurent I, Lobontiu A, Ahcel B, Verhaeghe JL, Meistelman C, Degueldre M, Villemot JP, Guillemin F (2005) Telerobotic-assisted laparoscopic hysterectomy for benign and oncologic pathologies: initial clinical experience with 30 patients. Surg Endosc 19:826–831

  9. 9.

    Magrina JF, Pawlina W, Kho RM, Magtibay PM (2011) Robotic nerve-sparing radical hysterectomy: feasibility and technique. Gynecol Oncol 121:605–609

  10. 10.

    Pecorelli S (2009) Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet 105:103–104

  11. 11.

    Leblanc E (2007) How I perform… vaginal preparation for a laparoscopic radical hysterectomy or the “Schautheim” procedure. Gynecol Obstet Fertil 35:263–264

  12. 12.

    Querleu D, Morrow P (2008) Classification of radical hysterectomy. Lancet Oncol 9:297–303

  13. 13.

    Pomel C, Atallah D, Le Bouedec G, Rouzier R, Morice P, Castaigne D, Dauplat J (2003) Laparoscopic radical hysterectomy for invasive cervical cancer: 8-year experience of a pilot study. Gynecol Oncol 91:534–539

  14. 14.

    Querleu D, Leblanc E, Cartron G, Narducci F, Ferron G, Martel P (2006) Audit of preoperative and early complications of laparoscopic lymph node dissection in 1000 gynecologic cancer patients. Am J Obstet Gynecol 195:1287–1292

  15. 15.

    Trimbos JB, Franchi M, Zanaboni F, Velden JVD, Vergote I (2004) State of the art of radical hysterectomy; current practice in European oncology centres. Eur J Cancer 40:375–378

  16. 16.

    Frumovitz M, dos Reis R, Sun CC, Milam MR, Bevers MW, Brown J, Slomovitz BM, Ramirez PT (2007) Comparison of total laparoscopic and abdominal radical hysterectomy for patients with early-stage cervical cancer. Obstet Gynecol 110:96–102

  17. 17.

    Boggess JF, Gehrig PA, Cantrell L, Shafer A, Ridgway M, Skinner EN, Fowler WC (2008) A case-control study of robot-assisted type III radical hysterectomy with pelvic lymph node dissection compared with open radical hysterectomy. Am J Obstet Gynecol 199(357):e1–e7

  18. 18.

    Persson J, Reynisson P, Borgfeldt C, Kannisto P, Lindahl B, Bossmar T (2009) Robot assisted laparoscopic radical hysterectomy and pelvic lymphadenectomy with short and long term morbidity data. Gynecol Oncol 113:185–190

  19. 19.

    Cibula D, Velechovska P, Slama J, Fisherova D, Pinkavova I, Pavlista D, Dundr P, Hill M, Freitag P, Zikan M (2010) Late morbidity following nerve-sparing radical hysterectomy. Gynecol Oncol 116:506–511

  20. 20.

    Landoni F, Maneo A, Cormio G, Perego P, Milani R, Caruso O, Mangioni C (2001) Class II versus class III radical hysterectomy in stage IB–IIA cervical cancer: a prospective randomized study. Gynecol Oncol 80:3–12

  21. 21.

    Cibula D, Slama J, Velechovska P, Fisherova D, Zikan M, Pinkavova I, Hill M (2010) Factors affecting spontaneous voiding recovery after radical hysterectomy. Int J Gynecol Cancer 20:685–690

  22. 22.

    Liang Z, Chen Y, Xu H, Li Y, Wang D (2010) Laparoscopic nerve-sparing radical hysterectomy with fascia space dissection technique for cervical cancer: description of technique and outcomes. Gynecol Oncol 119:202–207

  23. 23.

    Chen GD, Lin LY, Wang PH, Lee HS (2002) Urinary tract dysfunction after radical hysterectomy for cervical cancer. Gynecol Oncol 85:292–297

  24. 24.

    Wu J, Liu X, Hua K, Hu C, Chen X, Lu X (2010) Effect of nerve sparing radical hysterectomy on bladder function recovery and quality of life in patients with cervical carcinoma. Int J Gynecol Cancer 20:905–909

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We thank the patients who participated; and we thank Arnaud Payen. We also thank GCS “Centre de Référence Régional en Cancérologie,” Francoise Weingertner, and Cathy De Mendonca; and Direction Générale, Lille, France.


Drs. Narducci, Collinet, Merlot, Lambaudie, Boulanger, Lefebvre-Kuntz, Nickers, Taieb, Houvenaeghel, and Leblanc have no conflicts of interest or financial ties to disclose.

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Correspondence to Benjamin Merlot.

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Narducci, F., Collinet, P., Merlot, B. et al. Benefit of robot-assisted laparoscopy in nerve-sparing radical hysterectomy: urinary morbidity in early cervical cancer. Surg Endosc 27, 1237–1242 (2013). https://doi.org/10.1007/s00464-012-2582-z

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  • Atonic bladder
  • Cervical carcinoma
  • Radical hysterectomy
  • Robot-assisted laparoscopy
  • Urinary tract dysfunction