Radical Wertheim Hysterectomy With Bilateral Pelvic Lymph Node Dissection and With Extension of the Vagina

Radical Wertheim Hysterectomy With Bilateral Pelvic Lymph Node Dissection and With Extension of the Vagina

Radical Wertheim hysterectomy is performed predominantly for stage IB and early stage IIA carcinoma of the cervix and for stage I carcinoma of the vagina. It is also appropriate for stage II adenocarcinoma of the endometrium (corpus excervicus). The operation essentially includes removal of the uterus, upper vagina, and all the parametrial tissues to the pelvic side wall. The ureter and bladder are dissected free and left intact. 

Reconstruction of the vagina, if necessary, can be achieved by the technique of extension of the vagina, making a pocket out of the vesical peritoneum and the rectal serosa.

Physiologic Changes. Carcinoma of the vagina, cervix, and uterus is removed.

Points of Caution. 

 The major complications of the radical Wertheim hysterectomy are vesicovaginal and ureterovaginal fistulae in approximately 1.5% of patients.

Hemorrhage can be a problem. The danger areas from hemorrhage are the hypogastric vein and its tributaries (internal iliac vein), the vessels in the obturator fossa, and nuisance bleeding from the small vessels located in the tunnel of the ureter.

Postoperative urinary retention with bladder atony is a permanent problem in less than 10% of patients. It comes from the transection of (1) the sympathetic nerves to the bladder in the upper portion of the web and (2) the ureterosacral ligaments.

History:

Ernst Wertheim (February 21, 1864 - February 15, 1920) was an Austrian gynecologist born in Graz.

In 1898, Wertheim performed the first radical abdominal hysterectomy for cervical cancer. This operation involved removal of the uterus, parametrium, tissues surrounding the upper vagina, and pelvic lymph nodes. Afterwards, Wertheim surgery became a fairly common, although risky procedure for cervical cancer. He also did important research of gonorrhea in the female genital tract, and was the first physician to demonstrate the presence of gonococcus in the peritoneum. Wertheim also discovered that gonococcus grows best on a culture of agar mixed with human blood-serum.

  

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