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

Abstract

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-

Intergender differences in histological architecture of the fascia pelvis parietalis: A cadaveric study

“…However, despite recent general interest in elastin content (e.g., Goepel et al, 2008), few studies have focused on the specific fiber directions in the pelvic connective tissue because of low specificity for elastin in usual methods. In addition, the connective fiber architecture at and along the ATFP was shown in our previous studies (Niikura et al, 2007; Tamakawa et al, 2003).…”

Histotopography of the female cavernous nerve: a study using donated fetuses and adult cadavers

“…Although the present Fig. 5a also displays it, we previously presented good photographs showing that the adult perivaginal nerves run distally and cross the fibrous connective tissue between the vagina and endopelvic fascia, i.e., the level II support [1,18].…”

“…The female continence nerve, a pelvic nerve branch to the urethral smooth muscle, has been histologically described as traveling inferoanteriorly in the distal paracolpium between the lateral ends of the urethra and vagina [1][2][3][4][5]. In males, the intrapelvic continence nerve is joined by the cavernous nerve to form a neurovascular bundle.…”

Comparison of different classifications of radical hysterectomies: Complexifying or helping our understanding?

“…Два пространства расположены дорсаль-но: крестцово-маточное (медиальное околопрямокишечное) и околопрямокишечное (латеральное околопрямокишечное), а одно пространство локализуется вентрально -это околопузыр-ное пространство. Общеизвестно, что границами крестцово-ма-точного пространства являются прямая кишка и дорсальный па-раметрий, околопрямокишечное пространство располагается между дорсальным параметрием и подвздошными сосудами, а околопузырное пространство между вентральным параметрием и подвздошными сосудами [12,36,[41][42][43][44].…”