Annals of surgical oncology · 2026
Radical Hysterectomy: A Focus on Querleu-Morrow Type B.
СтатьяНазвание и аннотация: Перевод в очереди
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Bizzarri Nicolò, Guidi Giacomo, Ammar Sara, Rosati Andrea, Pedone Anchora Luigi, Fanfani Francesco, Fagotti Anna, Scambia Giovanni, Querleu Denis
Аннотация
BACKGROUND: The recently published SHAPE trial1 may limit the exposure of trainees to modified radical hysterectomy, Querleu-Morrow type B2. It is therefore timely to reestablish a simple description of the technique with an educational video.
MATERIALS AND METHODS: The steps of the Type B1 (modified radical hysterectomy) (Fig. 1) are as follows: step 1: preparation of lateral, ventral, and dorsal spaces (three steps); step 2: management of the uterine artery and of the parauterine lymphovascular tissue; step 3: unroofing of the ureter, division of the vesicouterine ligaments, and mobilization of the bladder base; step 4: division of the rectovaginal ligaments; and step 5: division of the paracervix at the ureter.
RESULTS: The B2 variant, characterized by adding a lateral paracervical lymph node dissection, and the recently described parauterine lymphovascular tissue (PULT)3,4 resection, will be also featured. Here are the steps for additional paracervical lymphadenectomy: step 1: separation from the obturator nerve; step 2: separation from the paravesical tissue; step 3: removing the ventral component of the paracervix (lateral "parametrium"); step 4: removing the dorsal component of the paracervix (internal iliac nodes); and step 5: removing the lateral component of the paracervix (presciatic nodes).
CONCLUSIONS: In this video, we analyzed the surgical technique for type B radical hysterectomy, focusing on dissection of the uterus and lymph nodes, including the PULT. This highlights the importance of maintaining standardization of the procedure throughout the generations of gynecologic oncologists.
MATERIALS AND METHODS: The steps of the Type B1 (modified radical hysterectomy) (Fig. 1) are as follows: step 1: preparation of lateral, ventral, and dorsal spaces (three steps); step 2: management of the uterine artery and of the parauterine lymphovascular tissue; step 3: unroofing of the ureter, division of the vesicouterine ligaments, and mobilization of the bladder base; step 4: division of the rectovaginal ligaments; and step 5: division of the paracervix at the ureter.
RESULTS: The B2 variant, characterized by adding a lateral paracervical lymph node dissection, and the recently described parauterine lymphovascular tissue (PULT)3,4 resection, will be also featured. Here are the steps for additional paracervical lymphadenectomy: step 1: separation from the obturator nerve; step 2: separation from the paravesical tissue; step 3: removing the ventral component of the paracervix (lateral "parametrium"); step 4: removing the dorsal component of the paracervix (internal iliac nodes); and step 5: removing the lateral component of the paracervix (presciatic nodes).
CONCLUSIONS: In this video, we analyzed the surgical technique for type B radical hysterectomy, focusing on dissection of the uterus and lymph nodes, including the PULT. This highlights the importance of maintaining standardization of the procedure throughout the generations of gynecologic oncologists.