Radical cervical cancer surgery pioneered by Wertheim 100 years ago has been the main treatment modality for early-stage cervical cancer with a 5-year survival rate of 80% to 90%, but bladder function, rectal dysfunction and sexual dysfunction caused by pelvic autonomic nerve injury after radical surgery are drawing more and more attention from patients and gynecologists. Recently, more and more modalities have been applied in the treatment of cervical cancer with good results, among which radical cervical cancer surgery with preservation of nerves can significantly reduce the incidence of postoperative pelvic organ dysfunction. Transvaginal radical cervical cancer surgery with simultaneous laparoscopic lymphadenectomy achieves a high cure rate while avoiding open abdomen. Radical cervical surgery makes it possible to preserve fertility while ensuring the effectiveness of cervical cancer treatment. Radical cervical cancer treatment via laparoscopy is less invasive than traditional transabdominal surgery. Robotic surgery has also gained wider acceptance in the management of gynecomas. 1. Nerve-preserving radical cervical surgery Since Wertheim first proposed open radical cervical surgery for cervical cancer, this technique has been continuously improved. Type III radical cervical surgery for cervical cancer has become the standard operation for the treatment of stage Ib-IIa cervical cancer, with a 5-year survival rate of over 80%. However, this operation is associated with a number of postoperative complications, such as bladder, colorectal and sexual dysfunction. The most common distant complication is bladder dysfunction, with an incidence of 8 to 80%. Anatomic and clinical studies have shown that these functional abnormalities are due to the rupture of the pelvic autonomic nerve caused during the removal of the parametrial tissue. Recently, studies have proposed nerve preservation surgery to prevent pelvic nerve dissection during radical cervical cancer surgery. In the 1960s, Kobayashi at the University of Tokyo first proposed preserving the parasympathetic nerve innervating the bladder during radical cervical surgery for cervical cancer, but it was not until 1988 that his student Sakamoto first published this “Tokyo procedure” in English. The first report of the nerve preservation technique in Western countries was by German scholars such as Hö ckel, who used suction to remove all lymphatic fatty tissue from the main ligament, exposed the supporting structures of the uterus, and identified the pelvic visceral plexus and pelvic plexus within the main ligament. In the seven patients they reported, the urinary catheter was removed at an average of 12 d postoperatively with a residual urine of less than 50 mL. Charoenkwan et al. concluded that the infra-abdominal nerve and infra-abdominal plexus are more important for maintaining bladder function and therefore the protection of the autonomic nerves in the uterosacral ligament should be emphasized when performing nerve preservation surgery, and in their report, when this approach was taken, 100% of urinary retention was resolved within 28 (residual urine <100 ml) within 28 days. This compares with only 2/3 of patients who would have had such an outcome after undergoing conventional radical cervical cancer surgery. By preserving the subvesical vein to identify and preserve the bladder branches of the pelvic visceral nerve, Fujii et al. achieved a residual urine of <50 ml in 11 of 24 patients within 14 d postoperatively, and all patients achieved that level within 21 d postoperatively. Does this affect the outcome of radical cervical cancer surgery with preservation of nerves, which reduces the extent of resection of parametrial tissue compared to conventional radical cervical cancer surgery?Steed et al. found that the rate of parametrial metastasis in 110 patients with stage Ia to Ib1 cervical cancer was only 5% and was associated with tumor size (3.0 cm), depth of infiltration (16 mm), and pelvic lymph node metastasis (40%).Pluta et al. found a positive rate of 8.3% for anterior lymph nodes in 60 patients with early-stage cervical cancer (3 stage Ia1, 11 Ia2, and 46 Ib1), and a mean follow-up of 47 months without recurrence after radical cervical surgery for nerve-preserving cervical cancer. Therefore, nerve preservation accomplished by reducing the extent of surgical resection (modified radical cervical cancer surgery) can obtain the same oncological effect and effectively reduce the pathogenicity rate. 2. Transvaginal radical cervical surgery for cervical cancer In 1902, Schauta was the first to perform radical cervical surgery for cervical cancer transvaginally. This route has the advantages of less intraoperative complications, shorter operation time and rapid postoperative recovery. In 1959, Mitra performed an extraperitoneal pelvic lymph node dissection in conjunction with radical transvaginal cervical cancer. However, it was not until laparoscopy was used for pelvic lymph node dissection that radical transvaginal cervical cancer gained renewed interest. Advances in laparoscopy have made endoscopic removal of lymph nodes safer and simpler. The development of laparoscopic instruments and techniques expanded its role in performing uterine artery ligation, ureteral tunneling, and main sacral ligament transection, effectively improving on the traditional transvaginal procedure performed by Schauta. Jackson et al. compared classical radical transvaginal cervical cancer surgery with radical transabdominal cervical cancer surgery in the treatment of early cervical cancer. In this retrospective comparative analysis, a total of 40 patients underwent radical transvaginal cervical cancer with laparoscopic lymph node dissection. Age, histologic staging, FIGO stage, and tumor volume were used as grouping criteria for comparison with 1:1 pairs of patients undergoing radical transvaginal cervical cancer with pelvic lymph node dissection. Conclusion: The transvaginal route resulted in faster recovery, shorter operative time and less blood loss. The transvaginal radical group had a higher risk of intraoperative bladder rupture, but all of them had no sequelae after repair. At 70 months postoperative follow-up, there were two recurrences in the transabdominal group, while there were no recurrences in the transvaginal group. In 1995, Dargent first introduced radical vaginal trachelectomy (RVT), i.e., radical cervical surgery with laparoscopic pelvic lymph node dissection. In 1997, Smith et al. first reported Radical abdominal trachelectomy (RAT), which is a radical cervical surgery with laparoscopic pelvic lymph node dissection, as another option to preserve fertility in the treatment of early-stage cervical cancer. Chen et al. reported 16 patients with stage Ia2 to Ib cervical cancer who underwent radical cervical trachelectomy with a mean operative time of 142 min, blood loss of 180 ml, hospital stay of 6.7 days, no intraoperative or postoperative complications, and a mean follow-up of 28.2 months with no recurrence. 5 had successful postoperative pregnancies, of which 2 lasted until late pregnancy, 2 miscarried at 24 and 26 weeks of gestation, and 1 is now 18 weeks pregnant. One case has now reached 18 weeks of gestation. In the case of RAT, Ungar reported 5 patients with cervical cancer at 7-18 weeks of gestation who had preserved the uterus and the embryo at the same time after RAT, and 2 patients had a full-term pregnancy and delivered successfully after surgery. A total of one intraoperative and six postoperative complications occurred in four patients, with a median follow-up of 32 months and no recurrence in any of them. three postoperative pregnancies were successful, one up to 31 weeks of gestation and two at full term. Although radical cervical surgery has been performed abroad, it is technically demanding, and the indications for the procedure are difficult to control and grasp, which may lead to postoperative recurrence and affect the patient's quality of life and survival rate after surgery. Patients are examined every 2 weeks at 18-28 weeks of gestation to determine the need for an IUD in the residual isthmus. For young patients with early-stage cervical cancer who require preservation of reproductive function, radical cervical surgery is a new procedure that has emerged only in the last decade and is not yet reported on a large scale. In order to avoid poor prognosis caused by too small treatment, we must be cautious, strictly grasp the indications for surgery, make clear diagnosis before surgery and follow up closely after surgery. In 1992, Nezhat et al. first reported laparoscopic radical hysterectomy (LRH) + pelvic and para-aortic lymph node dissection for cervical cancer. They reported 107 patients with stage Ib1 cervical cancer who underwent this treatment, 6 of whom were converted to open surgery. The median number of lymph nodes removed was 26, the median intraoperative blood loss was 200 m1, and the median operative time was 305 min. only 2 intraoperative complications occurred, and 5 patients required a second operation due to postoperative complications. 30 patients were found to have microscopic lymph node metastases. A total of 24 patients received adjuvant therapy. After 30 months of follow-up, only 11 recurred. This procedure has overcome the shortcomings of laparoscopic-assisted radical vaginal hysterectomy (LARVH), which requires two sets of surgical instruments and intraoperative changes of surgeon and patient position, and is now becoming more sophisticated. Malzoni et al. conducted a study on the number of patients who underwent total laparoscopic radical hysterectomy (TLRH) + lymph node dissection (65 cases) and transabdominal radical hysterectomy (ARH) + lymph node dissection (62 cases). The median intraoperative blood loss in the laparoscopic group was 55 m1, and the median hospital stay was 4 days, which was significantly better than the 145 ml and 7 days in the conventional transabdominal group, but the median operative time was 196 min, which was significantly longer than the 152 min in the transabdominal group, and the difference was statistically significant. There was no statistically significant comparison of recurrence rate between the two groups. There was no significant increase in intraoperative and postoperative complications while laparoscopic surgery exerted its superiority. xu et al. performed LRH + lymph node dissection in 317 patients with cervical cancer, with an intraoperative complication rate of 4.4% and a postoperative complication rate of 5.1%. uccella et al. performed LRH + lymph node dissection in 50 cases who received "TLRH + lymph node dissection "The results showed no statistical difference between the two groups in terms of intraoperative and postoperative urologic complication rates. Vascular injury is one of the more common and serious intraoperative complications of this type of surgery, with an incidence of 1.6% to 4.4%. The injury is mainly related to lymph node dissection and occurs mostly in the external iliac vein and vessels that have undergone mutation. Bladder injury is also a common complication of this type of surgery, with an incidence similar to that of vascular injury, mostly occurring when the cervical bladder gap is opened, and is more likely to occur in patients with a history of cesarean delivery or preoperative radiation therapy, most of which can be repaired microscopically, with only a few being converted to open abdomen. Bowel injury is also a more serious intraoperative complication, but occurs less frequently. Urinary retention is the most common postoperative complication, and almost all patients have varying degrees of difficulty urinating after surgery, but the reported incidence varies widely, ranging from 1.9% to 32.2%, because the definition of urinary retention is not identical, and the average time to recovery of bladder function after surgery is 10 to 16 days. The incidence of urinary complications ranged from 1.1% to 3.2% and included ureterovaginal fistula, vesicovaginal fistula and ureteral stricture, with the first two predominant. The feasibility and safety of laparoscopic surgery for the treatment of cervical cancer have been confirmed. It not only has the advantages of less trauma, less intraoperative bleeding, faster postoperative recovery and shorter hospital stay, but also has the same surgical effect as traditional transabdominal surgery, and the postoperative recurrence rate and mortality rate of patients are similar to those of transabdominal surgery. With the increase of experience and the improvement of the operator's technical level, the operation time will also be gradually shortened. Robotic surgery Robotic equipment-assisted operations have been rapidly developed and are widely used in different surgical fields. The advantages of this new technology include a three-dimensional view with free magnification of the field of view, tremor filtering, mobility of the instruments in the body, and a comfortable and fatigue-reducing console. In recent years, robotics has also been introduced in gynecologic oncology, and in 2007 Magrina reported on a study that included 142 patients with various gynecologic malignancies who were treated with the da Vinci robotic system. Eight patients in this group underwent robotic radical cervical cancer surgery with an average operative time of 218 minutes, 176 ml of blood loss, a hospital stay of 1.9 days, and a lymph node count of 27.9, with no intraoperative or postoperative complications. Robotic surgery is better than conventional laparoscopic surgery in the treatment of cervical cancer, mainly due to the advantages of increased flexibility with its improved instrumentation. In 2008, Magrina again reported on radical cervical cancer surgery performed with robotic assistance and obtained similar results as before. He performed 27 procedures while comparing 31 patients who underwent laparoscopic surgery with 35 patients who underwent conventional open surgery. Blood loss in the robotic group was significantly less than in the open and laparoscopic groups (133 mL; 443 mL; 208 mL). The length of hospital stay was 1.7 days, which was statistically significant compared with the open group (3.6 days) and also less than the 2.4 days in the laparoscopic group. There was no significant difference between the three groups in terms of lymph node count and intraoperative and postoperative complications, and none of the robotic operations ended up being converted to open surgery. Robotic systems are not without drawbacks, the most frequently mentioned being the lack of tension feedback, complexity of operation, and high cost. However, robotic technology is rapidly evolving and new instruments, smaller arm devices, the addition of a fourth arm device and the advent of palpable feedback are all about to become a reality. There is no doubt that the cost of robotic surgery is still relatively high at this stage, but with the widespread use of this technology, combined with shorter hospital stays, there is still great hope that the cost of surgery will be reduced. 6. Summary: Open radical cervical surgery is still the gold standard for radical cervical cancer treatment. With the progress of technology and further understanding of pelvic neurovascular anatomy, more and more new techniques will be more widely used in the treatment of cervical cancer. The feasibility and safety of nerve-preserving radical cervical cancer treatment has been fully confirmed. Radical cervical surgery brings hope of preserving fertility to patients with early-stage cervical cancer. Endoscopic performance of radical cervical cancer treatment has benefited from advances in laparoscopic and robotic technology. The combined use of multiple techniques will enable the treatment of early-stage cervical cancer to evolve toward a safer, more effective, and more economical direction.