J Gynecol Oncol.  2010 Dec;21(4):219-224. 10.3802/jgo.2010.21.4.219.

The twenty-first century role of Piver-Rutledge type III radical hysterectomy and FIGO stage IA, IB1, and IB2 cervical cancer in the era of robotic surgery: a personal perspective

• Piver MS
• Ghomi A

• KMID: 2173544
• DOI: http://doi.org/10.3802/jgo.2010.21.4.219

Abstract

Type III radical hysterectomy reported in 1974 by Piver, Rutledge, and Smith is considered worldwide by many as the standard surgical therapy for invasive cervical carcinoma stage IB and IIA. With the increasing number of robotic surgeries being performed for early stage cervical cancer worldwide, the purpose of the paper is to present our personal perspective of the 21st century role of Piver-Rutledge type III radical hysterectomy for stage IB cervical cancer in the era of robotic surgery using the da Vinci robot.

Keyword

Cervix cancer; Type III radical hysterectomy; Robotic surgey

MeSH Terms

Humans
Hysterectomy
Uterine Cervical Neoplasms

Figure

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  Fig. 1 In a class II hysterectomy the uterine artery is ligated medical to the ureter, whereas in a class III it is ligated as it originates from the internal iliac artery. From Piver MS, et al. Obstet Gynecol 1974; 44: 265-72, with permission from Obstetrics & Gynecology.5

• 

  Fig. 2 In a class II hysterectomy the uterosacral ligaments are divided midway between the uterus and their sacral attachments. In a class III operation the uterosacral ligaments are excised at their sacral attachments. From Piver MS, et al. Obstet Gynecol 1974; 44: 265-72, with permission from Obstetrics & Gynecology.5

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  Fig. 3 The medial one-half of the cardinal ligament is removed in a class II hysterectomy. In a class III operation the cardinal ligament is removed at the pelvic wall. From Piver MS, et al. Obstet Gynecol 1974; 44: 265-72, with permission from Obstetrics & Gynecology.5

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  Fig. 4 The upper one-third of the vagina is removed in a class II hysterectomy and one-half in a class III procedure. Not illustrated is removal of three-fourths of the vagina in class IV hysterectomy. From Piver MS, et al. Obstet Gynecol 1974; 44: 265-72, with permission from Obstetrics & Gynecology.5

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  Fig. 5 In a class III hysterectomy the ureter is dissected from the pubovesicle ligament superiorly, medially, and inferiorly. A small lateral portion of the pubovesicle artery is preserved, thus maintaining some blood supply to the distal ureter. From Piver MS, et al. Obstet Gynecol 1974; 44: 265-72, with permission from Obstetrics & Gynecology.5

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