Type of radical hysterectomy | Paracervix or lateral parametrium | Ventral parametrium | Dorsal parametrium |
A | Halfway between the cervix and ureter (medial to the ureter — ureter identified but not mobilized) | Minimal excision | Minimal excision |
B1 | At the ureter (at the level of the ureteral bed — ureter mobilized from the cervix and lateral parametrium) | Partial excision of the vesicouterine ligament | Partial resection of the rectouterine-rectovaginal ligament and uterosacral peritoneal fold |
B2 | Identical to B1 plus paracervical lymphadenectomy without resection of vascular/nerve structures | Partial excision of the vesicouterine ligament | Partial resection of the rectouterine-rectovaginal ligament and uterosacral fold |
C1 | At the iliac vessels transversally, caudal part is preserved | Excision of the vesicouterine ligament at the bladder. Proximal part of the vesicovaginal ligament (bladder nerves are dissected and spared). | At the rectum (hypogastric nerve is dissected and spared) |
C2 | At the level of the medial aspect of iliac vessels completely (including the caudal part) | At the bladder (bladder nerves are sacrificed) | At the sacrum (hypogastric nerve is sacrificed) |
D | At the pelvic wall, including resection of the internal iliac vessels and/or components of the pelvic sidewall | At the bladder. Not applicable if part of exenteration. | At the sacrum. Not applicable if part of exenteration. |
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