Piver‐Rutledge‐Smith (Piver 1974)
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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
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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
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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
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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
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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)
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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
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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
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B2 |
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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
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C2 |
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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
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D2 |
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GCG‐EORTC a (Mota 2008)
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Extent of surgery |
Type I |
Simple hysterectomy |
Type II: modified radical hysterectomy b
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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
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Type III: radical hysterectomy b
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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
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Type IV: extended radical hysterectomy b
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Type V: partial exenterationb
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