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: 15262112page revision: 10, last edited: 24 Mar 2008 16:43