For patients with cervical cancer, hysterectomy is a common treatment. During radical hysterectomy, the patient’s nerves are often severely traumatized, resulting in many inconveniences in the patient’s life afterwards and seriously affecting the quality of life. Radical hysterectomy with preservation of autonomic nerves is to preserve as many nerves as possible in order to minimize the inconvenience and improve the quality of life of patients with cervical cancer after surgery. This section will mainly explain about radical hysterectomy for cervical cancer with preservation of autonomic nerves. I. Preface (a) Classification of cervical cancer surgery What kind of surgery is surgery for cervical cancer? What kind of surgery for cervical cancer should be included? In fact, there are many debates on these two questions, but one of the most classic answers is Piver’s staging, which classifies cervical cancer surgery into five categories: the first category is extra-fascial hysterectomy; the second category is semi-radical hysterectomy, or modified radical hysterectomy, which is what we call type 2 cervical cancer surgery. It covers half of the main ligament and half of the cervical ligament. In addition, the uterine vessels should be severed from above the ureter; the third category is the classical radical hysterectomy, also called Wertheim-Meig’s procedure, which is what we call type 3 cervical cancer surgery. The requirements of this procedure are not particularly the same as those of type 2, but require a more extensive or radical resection, mainly of the parametrial and paravaginal tissues. The ureter should generally be separated to the entrance of the bladder. Also, the uterosacral ligament should be excised from its origin, but this is more difficult because the origin is in the sacrum. The main ligament is very clear, in the pelvic wall, and it is cut against the pelvic wall; the fourth type is the ultra extensive hysterectomy, which is what we call type 4. It has a little more resection than type 3; the fifth category is pelvic expansion clearing. (B) Classical radical hysterectomy The following are a few pictures to illustrate what a classical radical hysterectomy is. The figure below is a schematic diagram of the anterior view of a specimen. In the picture, we can see very clearly a main ligament which is cut against the pelvic wall. The other side is cut very wide instead of cutting out one by one and pulling it up. So, many years ago the Germans suggested that this hysterectomy should be of the uterus including the tracts of the uterus. He called these the uterine mesentery, and I think this is still the right term. Such a complete resection of the mesentery, such a radical hysterectomy, can be more in line with the concept of cancer surgery. The picture below shows the posterior view of this specimen. You can see the fundic ligament in it. Basically, 1/3 of the vagina is cut, but since the depth of the vagina varies from person to person, and some are very shallow, 1/3 of the vagina is not enough, so I personally think it is more reasonable to measure the distance from the tumor by a few centimeters. In fact, from the concept of Radical surgery for tumors, it means that the cutting edge is 4 centimeters from the tumor. If this 4 cm is not reached, it is not called Radical resection. This is a basic concept in oncology surgery. This is a schematic of the lateral view of the specimen. This surgery places a lot of emphasis on the resection of the main ligament. In this diagram, the actual fundic ligament should come to the front of the sacrum, which we basically can’t cut, no matter how you divide it, up to the edge of the bowel. Also, there is a superficial and a deep bladder uterosacral ligament, and the deep layer is cut when the bladder is pushed down, while the superficial layer is basically on the surface. A diagram of the coronal surface of this specimen is shown on the right. A radical hysterectomy should have its cutting edge. The cut edge of the main ligament and the cut edge of the fundic ligament can be seen in the diagram. This drawing is flawed, I think the lateral rectal fossa is drawn incorrectly, but the lateral bladder fossa is correct.