Discrepancies between classic anatomy and modern gynecologic surgery on pelvic connective tissue structure: Harmonization of those concepts by collaborative cadaver dissection

Yabuki, Yoshihiko; Sasaki, Hiromasa; Hatakeyama, Noboru; Murakami, Gen

doi:10.1016/j.ajog.2005.02.108

Cited by 101 publications

(100 citation statements)

References 15 publications

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“…This thin membrane seems to correspond with a loose connection between the neurovascular sheath for the deep uterine vein and parietal fascia covering the levator ani. Yabuki et al (2005) demonstrated that Okabayashi's space, developed between the mesorectum and proper rectal fascia in their understanding, enters the cranial chamber of the pararectal space. This entry might correspond with a space between the hypogastric nerve and histologically identified meso-ureter (asterisks in Fig.…”

Section: Discussionmentioning

confidence: 99%

“…The interpretation of surgical anatomy using histological terms that we will present next is essentially based on the hypothesis that the arcus tendineus fasciae pelvis can be identified by its histological structure. Recently, Yabuki et al (2005) demonstrated that, during radical hysterectomy, surgeons are able to enter the caudal chamber of the pararectal space via an opening or division of the arcus tendineus fasciae pelvis. The arcus tendineus fasciae pelvis seems to correspond with the histologically identified fascial bridge between the parietal fascia and another fascia around the vagina.…”

Section: Discussionmentioning

confidence: 99%

“…The deep layer of the VUL has been clearly demonstrated using cadaveric dissections (Ercoli et al 2005;Sakuragi et al 2005;Yabuki et al 2005) as well as surgery. However, detailed descriptions of nerve elements, such as terms for localization of ganglion cells and immunohistochemical characterization of nerve elements, require histologic terms corresponding with each step of dissection.…”

Section: Methodsmentioning

confidence: 99%

“…The deep, posterior leaf (layer) of VUL is a well-known structure developed during radical hysterectomy (Sakuragi et al 2005;Yabuki et al 2005) that contains vesical veins draining into the deep uterine vein (Fujii et al 2007). Identification and division of the VUL's deep layer are necessary to access a deep surgical space along the vagina, as well as mobilize the cervix.…”

Section: Methodsmentioning

confidence: 99%

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Surgical Anatomy of Intrapelvic Fasciae and Vesico-Uterine Ligament in Nerve-Sparing Radical Hysterectomy with Fresh Cadaver Dissections

Niikura

Katahira

Utsunomiya

et al. 2007

Tohoku J. Exp. Med.

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Radical hysterectomy has been performed for invasive cervical cancer, and autonomic nerve-sparing procedures have been developed to preserve bladder function. To perform and improve the nerve-sparing radical hysterectomy, it is important to understand anatomy of the intra pelvic fasciae, specially vesico-uterine ligament (VUL), because most of injuries to the nerves occurred during incision of the VUL in radical hysterectomy procedures. The objectives of the present study were to provide histological understanding of major structures found in nervesparing radical hysterectomy. Serial macroscopic slices (15-20 mm thick) from five female pelves were trimmed and prepared for paraffin-embedded histology. We noted an anatomical entity as "the visceroparietal fascial bridge", which corresponds with the macroscopically identified arcus tendineus fasciae pelvis. A histologically identifiable neurovascular pedicle to the bladder neck corresponded with the deep portion of VUL. These findings could help better preservation of autonomic nerves during radical hysterectomy and improve patient's quality of life after the operation. Translation of surgical anatomy into anatomic terminology enables us to have fruitful discussions with persuasive power by excluding any bias from individual surgeons.vesico-uterine ligament; paracolpium; parietal fascia; levator ani; radial hysterectomy; autonomic nerve © 2007 Tohoku University Medical Press Radical hysterectomy has been performed for invasive cervical cancer, and autonomic nervesparing procedures have been developed to preserve bladder function. To perform and improve the nerve-sparing radical hysterectomy, it is important to understand anatomy of the intrapel-

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Surgical Anatomy of Intrapelvic Fasciae and Vesico-Uterine Ligament in Nerve-Sparing Radical Hysterectomy with Fresh Cadaver Dissections

Niikura

Katahira

Utsunomiya

et al. 2007

Tohoku J. Exp. Med.

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“…358 on p. 438] or mesoureter [Yabuki et al, 2005] are known to be inferomedial extensions of the RF. Mitchell [1950] clearly demonstrated this extension toward the pelvic cavity by injecting a radiopaque substance into child cadavers.…”

mentioning

confidence: 99%

Development of the Human Retroperitoneal Fasciae

Matsubara

Murakami²,

Niikura

et al. 2009

Cells Tissues Organs

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Introduction: Although the renal fascia (RF), ureteral sheath, lateroconal fascia (LF) and hypogastric nerve are critical landmarks for retroperitoneal surgery, their laminar relationships require clarification. Materials and Methods: Horizontal sections (hematoxylin-eosin staining) of human fetuses at two different developmental stages [9–12 (3 fetuses, crown-rump length, CRL 40–65 mm) and 20–25 weeks of gestation (9 fetuses, CRL 152–220 mm)] were compared. Results: In the early-stage group, the pararenal space had already formed between the posterior RF and the transversalis fascia (TF). The anterior RF extended along the peritoneum and often fused with the latter. In the late-stage group, the posterior RF extended inferomedially toward the anterior aspect of the aorta and inferior vena cava. However, at the level of the renal hilus, the posterior RF was connected with vascular sheaths of the great vessels. The LF was seen developing as a fasciculation of the multilaminar structure in the pararenal space. However, on the posterolateral side of the colon after retroperitoneal fixation, the fusion fascia of the peritoneum could also be identified as LF. Conclusions: A common sheath for ureters and hypogastric nerves appeared to be likely on the inferior side of the kidney. The LF did not appear to be a primary structure such as the RF, but a result of secondary mechanical stress due to fatty tissue developing earlier along the TF than in the perirenal space. However, the suggested similarity between LF and fusion fascia in the plane occupied was a likely cause for misinterpreting the laminar configurations during surgery.

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Surgeon's Corner

Baratz¹

2008

Arch Ophthalmol

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Discrepancies between classic anatomy and modern gynecologic surgery on pelvic connective tissue structure: Harmonization of those concepts by collaborative cadaver dissection

Cited by 101 publications

References 15 publications

Surgical Anatomy of Intrapelvic Fasciae and Vesico-Uterine Ligament in Nerve-Sparing Radical Hysterectomy with Fresh Cadaver Dissections

Surgical Anatomy of Intrapelvic Fasciae and Vesico-Uterine Ligament in Nerve-Sparing Radical Hysterectomy with Fresh Cadaver Dissections

Development of the Human Retroperitoneal Fasciae

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