Improved bladder function in radical hysterectomy without worsening oncologic outcome - Resection of the posterior layer of the vesicouterine ligament with the procedure limited to the vesical veins - read online free

Sep 24, 2026

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Objective: Compare bladder function and cervical carcinoma relapse-free survival between classic Okabayashi nerve-sparing radical hysterectomy and a simplified nerve-sparing approach that resects only the vesical veins and some connective tissue of the posterior layer of the vesicouterine ligament. Methods: Retrospective historical control study including women >20 with cervical cancer stage IB1–IIB undergoing radical hysterectomy with pelvic lymphadenectomy (2009–2022). Primary outcome: relapse-free survival. Results: 114 patients; median follow-up 60 months; no significant difference in relapse-free survival. Simplified surgery improved both motor and sensory bladder function. Conclusion: Limited posterior-layer vesicouterine ligament resection restricted to vesical veins is effective, safe, and may better preserve bladder function without adverse oncologic outcomes.

LanguageEnglish

CategoryHealthcare

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Pages10

Reading Time25 min

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J Gynecol Oncol. 2024 May;35(3):e28 [https://doi.org/10.3802/jgo.2024.35.e28](https://doi.org/10.3802/jgo.2024.35.e28)[ ](https://doi.org/10.3802/jgo.2024.35.e28)pISSN 2005-0380·eISSN 2005-0399 Original Article Received: Jun 17, 2023 Revised: Oct 2, 2023 Accepted: Nov 26, 2023 Published online: Dec 13, 2023 Correspondence to Kenro Chikazawa Department of Obstetrics and Gynecology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama 330-8503, Japan. Email: [kendokenro@hotmail.com](kendokenro@hotmail.com) © 2024. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology, and Japan Society of Gynecologic Oncology This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ([https://](https://)[ ](https://)[creativecommons.org/licenses/by-nc/4.0/](creativecommons.org/licenses/by-nc/4.0/)) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ORCID iDs Kenro Chikazawa [https://orcid.org/0000-0002-8839-4483](https://orcid.org/0000-0002-8839-4483)[ ](https://orcid.org/0000-0002-8839-4483)Ken Imai [https://orcid.org/0000-0002-7593-7960](https://orcid.org/0000-0002-7593-7960)[ ](https://orcid.org/0000-0002-7593-7960)Tomoyuki Kuwata [https://orcid.org/0000-0002-9334-6670](https://orcid.org/0000-0002-9334-6670)[ ](https://orcid.org/0000-0002-9334-6670)Ryo Konno [https://orcid.org/0000-0002-9403-1339](https://orcid.org/0000-0002-9403-1339) Conflict of Interest K. Chikazawa received lecture honoraria from Ethicon (Tokyo, Japan), Terumo (Tokyo, Improved bladder function in radical hysterectomy without worsening oncologic outcome: resection of the posterior layer of the vesicouterine ligament with the procedure limited to the vesical veins Kenro Chikazawa , Ken Imai , Tomoyuki Kuwata , Ryo Konno Department of Obstetrics and Gynecology, Jichi Medical University, Saitama Medical Center, Saitama, Japan ABSTRACT Objective: The classic Okabayashi nerve-sparing radical hysterectomy involves complete resection of the posterior leaf of the vesicouterine ligament, whereas in the simplified nerve-sparing radical hysterectomy, only the vesical veins and some connective tissue of the posterior layer of the vesicouterine ligament are resected. This study aimed to compare bladder function and cervical carcinoma relapse-free survival between these two techniques. Methods: We conducted a retrospective, historical control study. All female patients aged >20 years who were diagnosed with cervical cancer stage IB1–IIB and underwent radical hysterectomy with pelvic lymphadenectomy between 2009 and 2022 were enrolled. Patients who had a history of other cancers and those who were treated with non-surgical approaches or non-radical hysterectomy were excluded. The primary outcome was relapse-free survival during the follow-up period. Results: A total of 114 patients who underwent curative-intent radical hysterectomy were included in this study. The median follow-up duration was 60 months. No significant difference was observed in relapse-free survival between the two surgical procedures. The simplified nerve-sparing radical hysterectomy was superior in terms of both motor and sensory bladder function outcomes. Conclusion: Resection of the posterior layer of the vesicouterine ligament, with the procedure limited to the vesical veins, is an effective and safe method for radical hysterectomy. It may be more useful for preserving the bladder function, without leading to unfavorable oncologic outcomes. Keywords: Hysterectomy; Uterine Cervical Neoplasms; Recurrence; Vesical Veins, Radical Hysterectomy Synopsis We compared two radical hysterectomy procedures, the classic Okabayashi procedure, and a simplified procedure with resection of the vesicouterine ligament limited to the veins. The simplified procedure produced supe

FAQs

What is the main difference between the classic and simplified nerve-sparing radical hysterectomy techniques?

The classic Okabayashi method resects the posterior leaf of the vesicouterine ligament, while the simplified approach resects only the vesical veins and some connective tissue of the posterior layer.

How was relapse-free survival assessed in this study?

Relapse-free survival was defined as the primary outcome and compared between the two surgical procedures during follow-up.

What were the key findings regarding bladder function and oncologic outcomes?

The study found no significant difference in relapse-free survival, while the simplified procedure produced superior motor and sensory bladder function outcomes and did not worsen oncologic outcomes.

Sep 24, 2026

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