Radical Hysterectomy

Abstract

The anatomic theory of the radical hysterectomy was described by the German surgeon Ries in 1895, but it was performed for the first time by an American, John Clark, at Johns Hopkins Hospital.¹⁰ In 1898 Wertheim began to do this operation for carcinoma of the cervix, and in 1912 he published a monograph that included 500 cases.¹¹ This procedure, together with the Schauta vaginal hysterectomy, became the mainstay of the surgical attack on cervical cancer in Europe and Great Britain. However, in the United States, radium and then radium and external radiation therapy were the most commonly practiced methods of treatment for cervical cancer until Meigs reintroduced radical hysterectomy and bilateral pelvic node dissection to American surgeons in 1944.⁵ Meigs, in contrast to the European surgeons, advocated complete and routine removal of the pelvic lymph nodes in every case. Interestingly enough, the radical abdominal hysterectomy is often called the Wertheim operation in the United States, whereas many European surgeons refer to it as the Meigs operation. The procedure described in this chapter is based largely on the technique first described by Okabayashi in 1921⁶ and expanded by Yagi in 1955.¹²