Under this procedure, the surgeon performs a medial approach for deep pelvic endometriosis, with rectal and parametrial involvement extending to the pelvic wall and somatic nerve or lateral approach for isolated endometriosis of pelvic wall and somatic nerves.
The procedure is fast gaining popularity since several patients are reported to achieve complete relief from pain within six months after surgery. The laparoscopic technique of nerve sparing for neurolysis and decompression of somatic nerves has proven to be more accurate and effective treatment. It is a safer and a more feasible approach for radical hysterectomy without compromising the extent of resection and rate of cancer recurrence as compared to standard techniques.
The technique is also especially useful for women with stage lb1 cervical cancer since it is more likely that there is better preservation of autonomic nerves during the nerve sparing radical hysterectomy than those with the higher stages of disease.
Radical hysterectomy with pelvic lymphadenectomy otherwise exemplifies the treatment of choice for early stage disease and even if it is performed by gynaecologist-oncologist, there are still chances of significant postoperative morbidity, especially for urinary bladder function. Nerve-sparing radical hysterectomy (NSRH) is thus a technique in which the neural part of the cardinal ligament which encloses the inferior hypogastric plexus, as well as the bladder branch (distal part of the plexus), remains intact. By this way, the bladder innervation is safe and its functional recovery is more rapid.
