Identification and preservation of the motoric innervation of the bladder in radical hysterectomy type III

Objective. To decrease postoperative morbidity associated with radical hysterectomy Rutledge type III, we identified the parasympathetic innervation of the bladder in the cardinal ligament. Methods. During laparoscopic dissection of the cardinal ligament, we used 7x magnification on 38 consecutive patients with cervical cancer stages IB1 to IIIA with high risk for parametrial involvement when we performed laparoscopy-assisted radical vaginal hysterectomy type III between August 1997 and January 1999. Results. The middle rectal artery was identified as a landmark separating the vascular from the neural part of the cardinal ligament. The neural part was shown to contain the splanchnic pelvic nerves which anastomose with the pelvic plexus. Following preservation of these neural structures all patients were able to void their bladder spontaneously. Following nerve-sparing technique, patients regained bladder function significantly quicker compared with a control group (n = 28) in which the neural part of the cardinal ligament had not been preserved: suprapubic drainage 11.2 days versus 21.4 days (P = 0.0007). Conclusion. Using the middle rectal artery as a landmark the neural part of the cardinal ligament can be preserved, resulting in preservation of the motor function of the bladder. (C) 2000 Academic Press.