There is no standard surgical treatment for patients with stage IB cervical cancer. The current primary operative approaches include class III radical hysterectomy (RH), class II RH, nerve-sparing RH, and individualization of surgical management such as Trachelectomy and Laparoscopic RH. The ideal surgical management of cervical cancer patients should be tailored on the basis of prognostic factors, age and quality of life. Within the discussion concerning the optimal level of radicality of hysterectomy, which is still controversial, the new concept of nerve-sparing RH has to be considered in order to reduce morbidity without compromising the oncological disease control, as well as laparoscopic approach to RH. The trend towards more conservative surgery is most relevant for younger women diagnosed with cervical cancer, for whom pregnancy may be an important issue. Radical Trachelectomy is a method of treating early invasive cervical cancers while retaining the body of the uterus. The radical trachelectomy can offer the chance of fertility preservation with good survival in well selected patients. The main issue is to define the inclusion criteria in a more extensive study. This paper reviews the evolution of concepts concerning the extent of radical hysterectomy for FIGO stage I cervical cancer.