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. 2019 Feb 12;2019(2):CD012828. doi: 10.1002/14651858.CD012828.pub2
Piver‐Rutledge‐Smith (Piver 1974) Extent of surgery
Class I:
extrafascial hysterectomy
  • Identification of ureters to avoid injury

  • Uterine vessels are resected and ligated close to the uterine isthmus

  • Uterosacral and cardinal ligaments are not removed

  • No vaginal portion is excised

Class II:
modified radical hysterectomy (Wertheim)
  • Ureters are dissected in the paracervical tissues but are not separated from the pubovesical ligament

  • Uterine arteries are resected and ligated beside and medial the ureter

  • Uterosacral and cardinal ligaments are excised up to the medial half portions

  • Vagina is excised up to the upper third level

  • Pelvic lymphadenectomy

Class III:
classical radical hysterectomy (Meigs)
  • Complete dissection of ureters from the pubovesical ligament except for the small part where the umbilical bladder artery is located to the level of their penetration into the bladder

  • Uterine arteries are cut off at the origin

  • Uterosacral and cardinal ligaments are resected as close to sacral insertion and pelvic side wall, respectively

  • Vagina is removed up to the upper half level

Class IV Class IV differs from the Class III according to the following issues;
  • Complete dissections of the ureters from the pubovesical ligament

  • Umbilical artery is sacrificed

  • Vagina is removed up to the three‐quarters level

Class V Class V differs from Class IV with the addition of the excision of a portion of the ureter or bladder which is involved by the tumour
Querleu and Morrow (Querleu 2008) Extent of surgery
Type A: minimum resection of paracervix
(extrafascial hysterectomy)
  • The position of ureters are determined by palpation or direct vision without freeing from their beds

  • The paracervix is transected medial to the ureter but lateral to the cervix

  • The uterosacral and vesicouterine ligaments are not transected at the distance from the uterus

  • Vaginal resection is at a minimum, generally less than 10 mm without removal of the paracolpos

Type B: transection of paracervix at the ureter B1
  • Ureters are unroofed and dissected laterally, permitting transection of the paracervix at the level of the ureteral tunnel

  • The posterior and deep neural component of the paracevix caudal to the deep uterine vein is not resected

  • At least 10 mm of the vagina from the cervix or tumour is excised

  B2
  • As described in B1 with additional removal of the lateral paracervical lymph nodes

Type C: transection of paracervix at junction with internal iliac vascular system C1
  • Uterosacral ligament is transected at the sacral insertion

  • Vesicouterine ligament is transected at the bladder

  • Ureters are mobilised completely

  • Vagina is excised at least 15‐20 mm from the tumour and the corresponding paracolpos is resected routinely

  • WITH the preservation of the autonomic nerves

  C2
  • As described in C1 but WITHOUT the preservation of the autonomic nerves

Type D: Laterally extended resection D1
  • Resection of the entire paracervix at the pelvic side wall along with the hypogastric vessels, exposing the roots of the sciatic nerve

  • Total resection of the vessels of the lateral part of the paracervix

  D2
  • As described in D1 plus resection of the entire paracervix with the hypogastric vessels and adjacent fascia and muscles

GCG‐EORTC a (Mota 2008) Extent of surgery
Type I Simple hysterectomy
Type II: modified radical hysterectomy b
  • The uterus, paracervix and upper vagina (10‐20 mm) are removed after dissection of the ureters to the point of their entry to the bladder

  • Uterine arteries are cut off and ligated

  • Medial half of parametria and proximal uterosacral ligaments are transected

Type III: radical hysterectomy b
  • En bloc removal of the uterus with the upper third of the vagina along with the paracervical and paravaginal tissues

  • Uterine arteries are cut off and ligated at their origin

  • The entire width of the parametria is resected bilaterally

  • The entire uterosacral ligament is resected

Type IV: extended radical hysterectomy b
  • Differs from Type 3, as three‐quarters of the vagina and paravaginal tissues are resected

Type V: partial exenterationb
  • Terminal ureters or segments of bladder or rectum are resected along with the uterus and parametria