Tohoku J. Exp. Med., 2007, 212(4)

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

HITOSHI NIIKURA,¹ ATSUKO KATAHIRA,¹ HIROKI UTSUNOMIYA,¹ TADAO TAKANO,¹ KIYOSHI ITO,¹ SATORU NAGASE,¹ KOHSUKE YOSHINAGA,¹ HIDEKI TOKUNAGA,¹ MASAFUMI TOYOSHIMA,¹ YUSUKE KINUGASA,² EIICHI UCHIYAMA,³ GEN MURAKAMI,² YOSHIHIKO YABUKI⁴ and NOBUO YAEGASHI¹

¹Department of Gynecology and Obstetrics, Tohoku University School of Medicine, Sendai, Japan
²Department of Anatomy, Sapporo Medical University School of Medicine, Sapporo, Japan
³Department of Surgical Oncology, Tokyo Medical and Dental University, Tokyo, Japan
⁴Department of Gynecology and Obstetrics, Hokuriku Central Hospital, Oyabe, Japan

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 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.

keywords —— vesico-uterine ligament; paracolpium; parietal fascia; levator ani; radial hysterectomy; autonomic nerve

© 2007 Tohoku University Medical Press

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Tohoku J. Exp. Med., 2007, 212, 403-413

Correspondence: Hitoshi Niikura, M.D., Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.

e-mail: niikura@mail.tains.tohoku.ac.jp