Retrograde Retroperitoneal Type B1 Radical Hysterectomy in Distorted Pelvic Anatomy: Our Experience

Introduction Retrograde hysterectomy is indicated when adhesion around the uterus is strong and the usual surgical method is not possible. We describe a technique of retrograde retroperitoneal type B1 radical hysterectomy in patients with distorted pelvic anatomy. Methods We performed the retrograde retroperitoneal type B1 radical hysterectomy in 17 patients during the period 2017–2019 in the department of surgical oncology at our centre. Eleven patients underwent this procedure for ovarian tumour as part of primary or interval cytoreduction, three patients for Grade IV endometriosis, one patient for locally advanced carcinoma rectum as part of posterior pelvic exenteration, and one patient for advanced carcinoma endometrium and as part of cytoreductive surgery (peritonectomy with HIPEC) in one patient with pseudomyxoma peritonei. Results Out of the 17 patients, only one patient had prolonged bladder morbidity which settled with conservative management. The patient who underwent the procedure as part of cytoreductive surgery had persistent increased frequency of stools for 1 month following the ileorectal anastomosis. She settled with conservative management and frequency of stools decreased. Two patients had wound morbidity. Conclusion Retrograde retroperitoneal type B1 radical hysterectomy with preservation of pelvic nerves is technically feasible thereby decreasing the postoperative morbidity in patients with distorted pelvic anatomy. The technique described by us is a boon to the surgeon on encountering a difficult pelvic anatomy during the surgery.