Radical hysterectomy is an extended hysterectomy that is intended to remove the uterus as well as a variable amount of soft tissue, for the purpose of achieving appropriate oncologic resection of a pelvic malignancy. While mainly utilized as primary surgical treatment of early stage cervical cancer, this operation may also be incorporated into the surgical management of extended operations for ovarian, colorectal or urologic malignancies. When utilized to treat cervical cancer, radical hysterectomy includes surgical assessment of the pelvic and sometimes paraaortic lymph nodes. Pelvic and paraaortic lymphadenectomy is covered in Chap. 32. When performed as a primary operation for cervical cancer, the oncologic margins include the endopelvic fascia ventrally, the lymph node-bearing tissue associated with the uterine vessels as well as the paravaginal portion of the cardinal ligament laterally, the uterosacral and rectovaginal ligaments dorsally, and the upper vagina distally. Resection of this addition soft tissue requires extensive mobilization of the distal ureters and bladder from the cervix and upper vagina. The upper rectum must be separated from the upper vagina. Variations of this operation are performed to resect other pelvic malignancies, depending on their extent. Radical hysterectomy may be performed by open or laparoscopic surgery. Major complications. Radical hysterectomycomplications of radical hysterectomy include urinary tract injury, bladder dysfunction, rectal injury, colorectal dysfunction, vaginal dehiscence, surgical site infection and sexual dysfunction.