腹腔镜根治性子宫切除术B型

                               
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Patient 45 y.o. 2 previous spontaneous delivery, with a diagnosis at conization of a squamous cervical cancer (Stage Ia2G2) was submitted to laparoscopic radical hysterectomy (Type B) with sistematic pelvic lymphadenectomy.

LAPAROSCOPIC RADICAL HYSTERECTOMY Type B: transection of paracervix at the ureter
Partial resection of the uterosacral and vesicouterine ligaments is a standard part of this category. The ureter is unroofed and rolled laterally, permitting transection of the paracervix at the level of the ureteral tunnel. The caudal (posterior, deep) neural component
of the paracervix caudal to the deep uterine vein is not resected. At least 10 mm of the vagina from the cervix or tumour is resected.
The operation corresponds to the modified or proximal radical hysterectomy and is adapted to early cervical cancer. The radicality of this operation can be improved without increasing postoperative morbidity by lymph-node dissection of the lateral part of the paracervix, thus defining two subtypes: B1 (as described); and B2, with additional removal of the lateral paracervical lymph nodes. The border between paracervical and iliac or parietal lymph-node dissection is defined arbitrarily as the
obturator nerve: paracervical nodes are medial and caudal. The combination of paracervical and parietal dissections is simply a comprehensive pelvic-node dissection. However, the lateral part of the paracervix has traditionally been resected fully in so-called type III–IV or distal radical hysterectomy. Paracervical lymphadenectomy has been invented to avoid clamping of the
paracervix at the pelvic wall, along with nerves and vessels, during radical hysterectomy. Paracervical lymphadenectomy is thus logically inserted in the subclassification of type B: the morbidity of type B2 does not differ from that of B1, although the combination of B1 with paracervical lymph-node dissection may be equivalent to that of type C1 resection.