Pocket ObGyn – Types of Hysterectomy
See Abbreviations
Simple (Extrafascial) Hysterectomy
- Only uterus (& cervix) For nonmalignant diagnoses or stage IA1 cervical cancer.
Radical Hysterectomy
- Uterus removed en bloc w/ parametrium (round, broad, cardinal, & uterosacral ligaments) & upper Ovaries can be preserved; bilateral pelvic LND usually included. For cervical cancer greater than stage IA1 or endometrial cancer involving cervix.
- Piver–Rutledge–Smith classification (1974): 5 classes of hysterectomy (I–V)
I: Simple extrafascial hysterectomy: Uterus & cervix only
II: Modified radical hysterectomy (Wertheim’s): Uterus, cervix, prox vaginal (1/3), parametrium/paracervix & uterine artery transected medial to ureter
III: Radical hysterectomy (Meigs–Wertheim): Uterus, cervix, prox vagina (1/3), uterine artery ligated at origin
IV: Extended radical hysterectomy: Uterus, cervix, 3/4 of vagina, superior vesical artery
V: Partial exenteration w/ removal of distal ureter &/or bladder Complications of radical hysterectomy (Gynecol Oncol 2009;114:75): Bladder/bowel
dysfxn (up to 85%); lymphocyst requiring drainage (3%); vesicovaginal (1%) or ureterovaginal (2%) fistula; PE or deep vein thrombosis (1–3%).
| Querleu–Morrow classification of radical hysterectomy | |||
| 4 types of radical hysterectomy (A–D, below) based on lateral extent of resection. Applies
to fertility preserving surgery and laparoscopic/robotic surgery. |
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| Type | Description | Surgical considerations | Indication |
| A | Minimal resxn of paracervix | Paracervix transected medial to ureter but lateral to cervix. Uterosacral & cardinal ligaments transected close to uterus. Vaginal resxn (<10 mm). | Early invasive cervical cancer (<2 cm), advanced cervical cancer after chemoradiation |
| B | Transection of paracervix at level of ureter | Partial resxn of uterosacral & cardinal ligaments. Ureter unroofed & mobilized laterally.Vaginal resxn
(10 mm). |
Early cervical cancer (stage 1A) |
| C1 | Transection of paracervix at junction w/ internal iliac artery (w/ nerve preservation) | Uterosacral ligament transected at rectum, cardinal ligament transected at bladder. Ureter mobilized. 15–20 mm
of vagina resected. Hypogastric nerves identified, preserved. |
Stages IB–IIA cervical cancer |
| C2 | Transection of paracervix at junction w/ internal iliac artery (w/o nerve preservation) | Paracervix completely transected. Hypogastric nerves not isolated or preserved. | Stages IB–IIA cervical cancer |
| D1 | Laterally extended endopelvic resxn | Resxn of entire paracervix (at pelvic sidewall) & hypogastric vessels | Pelvic exenteration |
| D2 | Laterally extended endopelvic resxn | D1 + resxn of entire paracervix, hypogastric vessels, & adj fascial or musc structures | Pelvic exenteration |
| From Querleu D, Morrow CP. Classification of radical hysterectomy. Lancet Oncol. 2008;9(3):297–303. doi:10.1016/ S1470-2045(08)70074-3. | |||