A NEW PROPOSAL FOR RADICAL HYSTERECTOMY

Objective: The authors revised the surgical procedure for radical hyst erectomy utilizing detailed observation of the venous system, connecti ve fascial sheets, and neural pathways within the uterine supports. St udy design: The anterior, middle, and, posterior uterine supports were reclassified into two systems, supporting or fascial and drainage or areoral. Supporting system consisted of the superficial layer of the v esicouterine ligament, fascial part of the Mackenrodt ligament, sacrou terine ligament, and rectovaginal Ligament, whereas drainage system co nsisted of the deep layer of the vesicouterine Ligament, vascular part of the Mackenrodt ligament, and the so-called mesoureter, The operati ve procedure was planned according to the continuity of these ligament s and executed first by excising the fascia and then dissecting the de nuded areoral tissue, Results: Among the 15 patients who underwent sur gery for uterine cancer during a 2-year period the mean (SD) time requ ired for the operation was 305.5 +/- 30.5 min and the mean (SD) total volume of blood loss 592.0 +/- 238.2 ml. A mean (SD) period of 14.3 +/ - 3.8 postoperative days was required until the volume of the residual urine decreased to less than 50 ml. Conclusion: The present operation has been structured more three-dimensionally and systematically than before. Further, safety of the operation was significantly improved in cluding prevention of hemorrhage and preservation of bladder function. (C) 1996 Academic Press, Inc.