Surgical anatomy of intrapelvic fasciae and vesico-uterine ligament in nerve-sparing radical hysterectomy with fresh cadaver dissections

Hitoshi Niikura, Atsuko Katahira, Hiroki Utsunomiya, Tadao Takano, Kiyoshi Ito, Satoru Nagase, Kohsuke Yoshinaga, Hideki Tokunaga, Masafumi Toyoshima, Yusuke Kinugasa, Eiichi Uchiyama, Gen Murakami, Yoshihiko Yabuki, Nobuo Yaegashi

Research output: Contribution to journalArticlepeer-review

23 Citations (Scopus)

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 nerve-sparing 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 viseroparietal 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.

Original languageEnglish
Pages (from-to)403-413
Number of pages11
JournalTohoku Journal of Experimental Medicine
Volume212
Issue number4
DOIs
Publication statusPublished - 2007 Jul 27

Keywords

  • Autonomic nerve
  • Levator ani
  • Paracolpium
  • Parietal fascia
  • Radial hysterectomy
  • Vesico-uterine ligament

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

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