It is widely accepted that nerve-sparing radical hysterectomy is associated with less postoperative morbidity than is observed in radical hysterectomy, while clinical safety is similar between the two. However, there is insufficient evidence to compare the laparoscopic approaches to these procedures. We performed a systematic review and meta-analysis to compare clinical efficacy and the rate of bladder dysfunction, including urodynamic assessment, between laparoscopic nerve-sparing radical hysterectomy (LNSRH) and laparoscopic radical hysterectomy (LRH). Thirty articles including 2743 participants were included. Operating times were shorter (MD=29.88 min, 95% CI=11.92 to 47.83) and hospital stays longer (MD=-1.56 d, 95% CI=-2.27 to -0.84) in LRH than in LNSRH. In addition, blood loss and the number of resected lymph nodes were not significantly different between the two. However, resected parametrium lengths (MD=-0.02 cm, 95% CI=-0.05 to -0.00) and vaginal cuff widths (MD=-0.06 cm, 95% CI=-0.09 to -0.04) were smaller in LNSRH. Furthermore, LNSRH tended to result in more satisfactory micturition (OR=2.90, 95% CI=2.01 to 4.19), shorter catheterization times (MD=-7.20 d, 95% CI=-8.10 to -6.29) and shorter recovery to normal post-void residual urine times (MD=-7.71 d, 95% CI=-8.92 to -6.50). Other bladder dysfunction symptoms, including urinary retention, nocturia, dysuria, urinary incontinence and frequent/urgent symptoms, were more likely to occur in the LRH group. Furthermore, LNSRH achieved better results in urodynamic assessments (all P<0.05). In conclusion, LNSRH was associated with lower rates of impaired bladder function and a shorter extent of resection than were observed in LRH. Clinical applications involving LNSRH should be explored with caution.
Journal of minimally invasive gynecology. 2018 Oct 22 [Epub ahead of print]
Jiayue Wu, Taiyang Ye, Jianwei Lv, Zhihong He, Jie Zhu
Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Key Laboratory of Gynecologic Oncology, China., Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China., Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Key Laboratory of Gynecologic Oncology, China. Electronic address: .