GYN Surgery

Types of Hysterectomies, Defined

  • Class I (Simple hysterectomy or total abdominal hysterectomy(extrafascial))
    • Structures: Removal of the cervix, uterus and a small cuff of the upper vagina.
    • Surgery of choice for endometrial CA
  • Class II (Modified radical extended hysterectomy (extended))
    • Mobilization: ureters are dissected and
    • Parametrium: Removal of the parametrial and paracervical tissue medial to the ureters.
    • preservation of the pubovesicle ligament for purposes of ureteral blood supply
  • Class III (Radical abdominal hysterectomy)[1]
    • Mobilization of the bladder as well as the rectum.
    • Parametrium: take parametria tissue to pelvic side wall.
    • Vaginal Cuff: upper 1/3 of the vagina (upper 1/3)
    • Structures: remove uterosacral and cardinal ligaments,
  • Class IV (Extended radical hysterectomy)
    • Vaginal cuff, more is taken.
    • Structures: remove ureter, bladder

Pelvic Exenteration

  • En masse removal of pelvic viscera for presenting stage IVA and recurrent disease.
  • Removes the following:
    • Radical Hysterectomy
    • pelvic LN dissection
    • removal of the bladder (anterior exenteration)
    • rectosigmoid colon (posterior exenteration)
    • both bladder and rectosigmoid (total exenteration)

Surgery and Use

Cervical Cancer

Stage Surgery Additional
0 or Ia1 TAH or Conization N/A
Ia2 (< 4 cm) or Ib1 Rad-HYs PLND for > 5 mm invasion
  • for patients with Ib2+ ChemoRad is generally recommended.

Endometrial Cancer


Stage Surgery Additional
I TAH BSO (bilateral salphingo-oophorectomy)
inspection and palpation of abdominal organs
Peritoneal washings
Pelvic and Para-aortc lymphadenectomy
II and IIIA Radical Hysterectomy BSO (bilateral salphingo-oophorectomy)
inspection and palpation of abdominal organs
Peritoneal washings
Pelvic and Para-aortc lymphadenectomy
Bibliography
1. Piver MS, Rutledge F, Smith JP. Five classes of extended hysterectomy
for women with cervical cancer. Obstet Gynecol 1974;44:265–72.
2. Hoffman MS. Extent of radical hysterectomy: evolving emphasis.
Gynecol Oncol. 2004 Jul;94(1):1-9. Review. PMID: 15262112
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