LIPOSUCTION-ASSISTED NERVE-SPARING EXTENDED RADICAL HYSTERECTOMY - ONCOLOGIC RATIONALE, SURGICAL ANATOMY, AND FEASIBILITY STUDY

OBJECTIVE: Our purpose was to improve the therapeutic index of radical hysterectomy by extending the resection of parametrial tissue without further impairing pelvic autonomic nerve functions. STUDY DESIGN: We studied the topographic anatomy of the parametrial tissue with high-re solution magnetic resonance imaging and by dissection of fresh human c adavers. We then performed a clinical feasibility study of the liposuc tion-assisted nerve-sparing extended radical hysterectomy RESULTS: Mag netic resonance imaging demonstrated thai the perispinous adipose tiss ue is retained after type III radical hysterectomy and is a frequent s ite of tumor recurrence. The perispinous adipose tissue contains the p elvic plexus, the pelvic splanchnic nerves, small blood vessels, and l ymphatic tissue. We developed the liposuction-assisted nerve-sparing e xtended radical hysterectomy and applied it to seven consecutive patie nts with cervical or vaginal cancer. No intraoperative or postoperativ e complications occurred. Postoperative magnetic resonance imaging ass ured us that perispinous adipose tissue was cleared in all cases. A me tastatic lymph node was found in the perispinous adipose tissue remove d by liposuction from one patient. Suprapubic cystostomies could be re moved after a median period of 12 days. CONCLUSION: The nerve-sparing removal of perispinous adipose tissue by liposuction is a feasible add ition to wide en bloc parametrectomy in anatomically defined planes.