Vesicouterine ligament contains abundant autonomic nerve ganglion cells: the distribution in histology concerning nerve-sparing radical hysterectomy

Abstract

The aim of this study is to describe the histologic architecture of the tissues corresponding to the surgically developed connective tissue bundle commonly referred to as the posterior leaf of the vesico-uterine ligament (VUL), and to examine distribution of ganglion cells. Serial macroscopic slices, each 15-20 mm in thickness, were made from eight specimens (obtained from six female elderly cadavers). In these macroslices, the location of the deep uterine vein was used to identify the deep leaf of the VUL. The specimens were trimmed and semi-serial histologic sections in thickness were prepared at 1 mm intervals. Vesical veins and the associated nerve elements were enclosed by fascia and formed a common pedicle. The base of the pedicle contained the deep uterine vein trunk. The fascia encircling the pedicle varied in thickness and connective intensity between specimens. This vesical neurovascular bundle contained abundant ganglion cells. On average, 48.0% of the ganglion cells along the vesical tributaries of the deep uterine vein were located on the medial or vaginal side of the veins, 19.2% were located between veins, 13.0% on the lateral side of the veins, and 19.8% on the dorsal side. The interindividual variability was greatest on the dorsal side of vesical veins and ranged 11-202 cells. We conclude that in order to achieve maximal preservation of the ganglion cells during the surgical dissection of the posterior leaf of the VUL, care must be taken when the medial or vesical aspect of the ligament is separated. The standard nerve-sparing radical hysterectomy should be modified to reflect differences in the distribution of ganglion cells and in connective intensity between ganglions and veins.

Individualized Radical Hysterectomy Procedure Using Intraoperative Electrical Stimulation for Patients With Cervical Cancer

“…Our previous report, however, suggests that up to 48% of the ganglion cells were located on the medial side of the deep uterine vein. 19 It is for this reason that we think that processing the posterior sheath of the vesicouterine ligament is an effective technique in nerve preservation. Some reports suggest that nerve preservation is enabled by separating the nerve fascicles from the blood vessel sheath and excising only the uterine branch.…”

“…Our prior report also describes the patterns by which the vesical vein and the ganglion cells relate. 19 In addition to the ganglion cells, the nerve tract itself also has some variations in its relationship with the vesical vein. Nerve preservation is easily performed in cases where the nerve fascicle exists mainly on the dorsal side of the vesical vein.…”

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

“…Recently, our group reported that intrasurgical electrostimulation of the VUL's deep layer results in detrusor activity in the bladder (Katahira et al 2005). Thus, the deep layer probably contains detrusor nerve fibers and ganglions originating from the pelvic splanchnic nerve and going toward the bladder neck via the pelvic plexus (Katahira et al 2007). Therefore, adequate treatment of the VUL deep layer may become the most critical step of any nerve-sparing procedure.…”

Anatomical basis of female pelvic cavity for nerve sparing radical hysterectomy

“…It was found by Katahira et al [10] that there were abundant autonomic ganglion cells in the deep layer of the VCL, 48.0, 19.2, 13.0 and 19.8 % of cells were located in the medial, middle, lateral side, and dorsal sides of the vesical vein, respectively. Therefore, caution is required when dealing with the deep layer of the VCL, especially the medial side, to ensure maximum preservation of the ganglion cells.…”