Modified Radical Hysterectomy

Modified radical hysterectomy (MRH) is thought to be equivalent to class II (Piver classification) or type B (Querleu classification) radical hysterectomy (RH) and identical to the original method of the Wertheim operation. MRH is a method of hysterectomy defined as being intermediate between simple hysterectomy and RH and enabling almost full preservation of the pelvic splanchnic nerves and hypogastric plexus. This surgical procedure entails the cutting of the anterior leaf, not the posterior one, of the vesicouterine ligament of the uterus. The ureter is mobilized laterally, part of the parametrial tissue is transected at the level of the ureteral tunnel, and at least 10 mm of the vaginal wall from the uterine cervix is removed. The indication of MRH (with pelvic lymphadenectomy) in cervical cancer is International Federation of Gynecology and Obstetrics stage IA1 with lymphovascular space invasion or stage IA2. MRH is associated with a very low (≤1%) rate of significant postoperative complications, and compared with RH, it reduces the rate of adverse effects on the urinary tract, such as fistula formation and severe voiding dysfunction. The mortality rate for those undergoing this procedure is 0.4–0.5%. The possibility of MRH for low-risk FIGO stage IB1 patients has been considered, and clinical trials are ongoing.