History and Classification of Radical Hysterectomy. Korea University Jae Yun Song

Transcription

1 History and Classification of Radical Hysterectomy Korea University Jae Yun Song

2 Contents Introduction History of radical hysterectomy Classification of radical hysterectomy

3 Introduction Hysterectomy Hystera (womb) + ectomy mentioned in Greek manuscripts 2000 years ago

4 History of Surgery Pain, infection, hemorrhage, the lack of effective antibiotics, anesthetics, and blood transfusion products John Collins Warren : removing a patient s cancerous salivary glands, in 1846 Joseph Lister : antiseptic techniques, in 1867 ability to transfuse blood : in the 1930s the discovery of antibiotics : in the 1940s

5 Ancient If the whole uterus has become black, one must cut it off in its entirety Soranus (98 138)

6 First attempt for vaginal excision professor at the University of Bologna from 1502 to 1527 use of mercurial ointment in the treatment of syphilis excised the uterus for prolapse removal of the cervix and lower part of the uterine corpus Giacomo Berengario da Carpi ( )

7 Early surgical attempts Osiander (Germany) The first planned elective hysterectomy (1801) excision of the cervix for cancer G.B. Palletta (Italian) inadvertently performed a vaginal hysterectomy patient died 3 days later from sepsis

8 Who is first success? The first planned, successful vaginal hysterectomy was performed in 1813 performed the procedure without anaesthesia or assistance 50-years old patient with ulcerated cervix died 26 years later Removed uterus was lost Conrad Langenbeck ( )

9 First laparotomy The founder of surgical gynecology The first to successfully remove an ovarian tumor (1809) Publish the first three successful cases of ovariotomy in 1817 Demonstrating the feasibility of elective abdominal surgery Ephraim McDowell ( )

10 Abdominal Hysterectomy but Charles Clay ( ) On November 17, 1843 no anesthetic and was merely provided brandy and milk for pain relief massive ovarian cysts; however, on this occasion, the uterus was replaced by a massive myoma Performed a Subtotal Hysterectomy the patient died of massive hemorrhage 16th January 1844 large ovarian cyst with 9-kg fibroid uteri subtotal hysterectomy and bilateral salpingooophorectomy 13th postoperative day she was dropped from the bed

11 First successful subtotal hysterectomy June, 1853 the first successful albeit unplanned abdominal subtotal hysterectomy Although this case terminated favorably, I would not easily be introduced to make another attempt Walter Burnham ( )

12 First planned subtotal hysterectomy Gilman Kimball ( )

13 Wertheim Performing a Gynecological Operation by the Austrian portraitist John Quincey Adams. History of radical hysterectomy

14 Pioneer of Radical hysterectomy In January 1878, the first abdominal extirpation of a cancerous uterus Developed a standardized technique for total abdominal hysterectomy Use of clamps and systematic suturing of the broad ligament, uterine vessels, and the cardinal and uterosacral ligaments Wilhelm Alexander Freund ( )

15 Radical Vaginal Hysterectomy The first description of blind ureteric catheterization in females under digital control in 1886 The first planned cystectomy in a patient with bladder cancer Radical vaginal hysterectomy (RVH) in 1880 and published his first 3 cases Karl Pawlik

16 Radical abdominal hysterectomy On November 16, 1898, Wertheim performed his first radical abdominal hysterectomy for cervical cancer Removal of the uterus, parametrium, tissues surrounding the upper vagina, and pelvic lymph nodes 50% operability rate, 18.6% mortality rate, and 42.4% 5-year cure rate in a series of 500 cases Ernst Wertheim ( ) Died on February 15, 1920, at the age of 56 because of the influenza pandemic

17 Radical vaginal hysterectomy Friedrich Schauta ( ) Referred to as a teacher in the shadow of his student Performed his first extensive RVH in 1901 Reported on 564 cases in 1908 with a 48.7% operability rate, 10.8% mortality rate, and 39.7% 5-year cure rate. Operative mortality was 9.8% Mentor to his student (Ernst Wertheim) Introduction of laparoscopy into oncologic surgery

18 Pioneer of nerve-sparing surgery Modified the Wertheim operation and extended the radicality of the operation in 1921 Characterized by the extensive resection of the parametriums and separation of the posterior leaf of the vesicouterine ligament. Hidekazu Okabayashi

19 Kobayashi : modified the Okabayashi RH and identified the principles for the prevention of bladder dysfunction, in 1961 Fujiwara : emphasized the importance of preserving the bladder branch of the inferior hypogastric plexus and pelvic splanchnic nerves, in 1983 Sakamato : minor modification of the Kobayashi method cardinal ligaments could be seen as 2 main parts: vascular and neural Yabuki et al : proposed new terminology and another modification of nerve-sparing RH Fujii : first showed how to preserve pelvic autonomic nerves, only dividing the uterine branch from the inferior hypogastric plexus

20 Radical hysterectomy with PLND Impressed with the logic of Ernst Wertheim s operative procedure Modified the Wertheim hysterectomy by adding more extensive pelvic lymphadenectomy Combined bilateral pelvic lymph node dissection with the standard Wertheim operation In 1944, published a article that reestablished the surgical approach for the treatment of cervical carcinoma. Joe Vincent Meigs ( )

21 Pelvic exenteration Hypothesized that ultraradical dissection of organs in the pelvic area might eradicate the disease brutal and cruel, but one that saved lives. Alexander Brunschwig

22 Radical vaginal trachelectomy Pioneer of both the conservative surgical management of cervical carcinoma and the use of the sentinel node concept in the management of cervical carcinoma Referred to as radical vaginal trachelectomy The first successful systematic conservative surgical approach for invasive cervical carcinoma was reported, in 1994 Daniel Dargent ( )

23 Classification of radical hysterectomy

24 Piver-Rutledge-Smith (in 1974) Classification of hysterectomy

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29 Querleu Morrow (2008) Classification of Radical hysterectomy

30 Type A: Limited Radical Hysterectomy not a simple extrafascial hysterectomy Vaginal resection is minimal, routinely less than 10 mm Type B: Resection of the Paracervix at the Ureter caudal limit must not involve the inferior hypogastric plexus Approximately 10 mm of the vagina from the caudal edge of the cervix or tumor type B1 : not involve resecting the nodes of the lateral part of the paracervix type B2 : Combined with pelvic lymphadenectomy

31 Type C: Transection of the Paracervix at its Junction with the Internal Iliac Vascular System Type C1: Nerve-preserving Radical Hysterectomy Type C2: No Preservation of Autonomic Nerves Type D: Laterally Extended Resection Type D1: Resection of the Entire Paracervix at the Pelvic Sidewall, ith the Hypogastric and Obturator Vessels, Exposing the Roots of the Sciatic Nerve. Type D2: D1 Plus Resection of the Adjacent Fascial/ Muscular Structures

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35 The history of mankind is the history of challenge and response Arnold Joseph Toynbee

36 Thank you for your attention