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The Wertheim hysterectomy: Development, modifications, and impact in the present day

Published:January 14, 2017DOI:https://doi.org/10.1016/j.ygyno.2017.01.011

      Highlights

      • Wertheim's radical abdominal hysterectomy technique is outlined.
      • Major modifications to the Wertheim hysterectomy are discussed.
      • Modern modifications focused on quality of life are examined.

      Abstract

      Ernst Wertheim was a pioneer in the history of the surgical treatment of cervical cancer. His English-language manuscript “The extended abdominal operation for carcinoma uteri (based on 500 operative cases),” which was published in 1912, detailed his standardization of the radical hysterectomy and formed the basis of the current treatment for early stage cervical cancer. We contextualize the Wertheim hysterectomy, emphasizing medical advances that allowed for its development and subsequent modification. We then discuss modifications to the originally proposed procedure, including a maximally extended parametrical resection pioneered by Takayama, and the addition of the Taussig en bloc lymph node dissection by Meigs, both of which afforded an improved mortality profile due to decreased disease recurrence. Finally, we discuss progress that has been made in the present day, such as the development of nerve-sparing and fertility-sparing surgeries, as well as the introduction of the robotic platform. In this way, we hope to provide a historical background for the Wertheim hysterectomy—a cornerstone of gynecologic oncology.

      Keywords

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