Retrograde Retroperitoneal Type B1 Radical Hysterectomy in Distorted Pelvic Anatomy: Our Experience
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ORIGINAL ARTICLE
Retrograde Retroperitoneal Type B1 Radical Hysterectomy in Distorted Pelvic Anatomy: Our Experience Shanmugasundaram Gouthaman1 • Sivasundari Maharajan2
•
Jagadesh Chandra Bose Soundarajan1
Received: 29 June 2020 / Revised: 27 July 2020 / Accepted: 7 August 2020 / Published online: 31 August 2020 Ó Association of Gynecologic Oncologists of India 2020
Abstract Introduction Retrograde hysterectomy is indicated when adhesion around the uterus is strong and the usual surgical method is not possible. We describe a technique of retrograde retroperitoneal type B1 radical hysterectomy in patients with distorted pelvic anatomy. Methods We performed the retrograde retroperitoneal type B1 radical hysterectomy in 17 patients during the period 2017–2019 in the department of surgical oncology at our centre. Eleven patients underwent this procedure for ovarian tumour as part of primary or interval cytoreduction, three patients for Grade IV endometriosis, one patient for locally advanced carcinoma rectum as part of posterior pelvic exenteration, and one patient for advanced carcinoma endometrium and as part of cytoreductive surgery (peritonectomy with HIPEC) in one patient with pseudomyxoma peritonei. Results Out of the 17 patients, only one patient had prolonged bladder morbidity which settled with conservative management. The patient who underwent the procedure as part of cytoreductive surgery had persistent increased frequency of stools for 1 month following the ileorectal anastomosis. She settled with conservative management and frequency of stools decreased. Two patients had wound morbidity. Conclusion Retrograde retroperitoneal type B1 radical hysterectomy with preservation of pelvic nerves is technically feasible thereby decreasing the postoperative morbidity in patients with distorted pelvic anatomy. The technique described by us is a boon to the surgeon on encountering a difficult pelvic anatomy during the surgery. Keywords Retrograde retroperitoneal type B1 radical hysterectomy Okabayashi space Latzko’s space Clavien–Dindo classification
Introduction
& Shanmugasundaram Gouthaman [email protected] Sivasundari Maharajan [email protected] Jagadesh Chandra Bose Soundarajan [email protected] 1
Department of Surgical Oncology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research (Deemed University), No. 1, Ramachandra Nagar, Porur, P. O. Box 600116, Chennai, India
2
Department of Obsterics and Gynaecology, Saveetha Medical College and Hospital, Chennai, India
Hysterectomy may not be straightforward as described in textbooks in conditions like pseudomyxoma peritonei, ovarian malignancy with large pelvic deposits, advanced endometrial malignancy and grade IV endometriosis due to dense adhesions and disease in the Pouch of Douglas. Retrograde hysterectomy is indicated when adhesion around the uterus is strong making the usual surgical method not possible, external endometriosis, ovarian tumour with strong adhesion in the
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