1323 Uro-functional Outcomes of Type C2 Selective Nerve-Sparing and Type C1 Radical Hysterectomy

Introduction/Background To investigate the uro-functional outcomes after Type C1 and Type C2 selective nerve-sparing radical hysterectomy (RH). Methodology 33 Type C1 RH cases were compared to 8 Type C2 selective nerve-sparing RH (Type C2N) cases with regard to uro-functional outcomes. All the procedures were performed under the mentorship of single surgeon (gynecologic cancer surgeon and anatomist), between October 2020 and December 2023. During Type C1 RH the vesicovaginal ligament superior to the vesical branches of the inferior hypogastric plexus (IHP) was excised. During selective nerve-sparing Type C2 RH, the uterine vein was cut from the internal iliac vein level, dissected medially over the IHP, and excised together with the vesicovaginal ligament. Afterwards, the lateral tissue to the hypogastric nerve plate, the remaining paracervix and lymph nodes were excised totally. Results The median time to spontaneous voiding was 6 days (5–33) in the Type C1 RH arm and 8 days (6–18) in the Type C2 selective nerve-sparing RH arm. The operation time, blood loss, and minor complications were not significantly different. In the Type C2N arm one patient had vesicovaginal fistula. The only thing that increased the time to spontaneous voiding, >10 days, was the use of thermal energy at the infraureteric ventral parametrium. Conclusion Type C2 selective nerve-sparing RH provides a more radical parametrectomy than Type C1 RH. On the other hand, uro-functional outcomes of Type C2N and Type C1 RH are similar. We suggest suture ligation rather than thermal energy for the management of paravaginal veins at the infraureteric ventral parametrium. Disclosures None.