Abstract
The cardinal ligament (CL) of the uterus is present as a specific part of the parametrium when the pararectal and paravesical spaces are developed surgically. According to usual nerve-sparing radical hysterectomy (the Tokyo method), the CL is divided into two parts, the vascular part for dissection and the nerve part that contains the pelvic splanchnic nerve (PSN) as a major target for nerve sparing. In contrast, we hypothesized that the CL and another structure outside of the usual area for surgical dissection, that is, the lateral rectal ligament, are mutually continuous and that the PSN runs through the lateral ligament rather than the CL. In the present study, a combination of routine dissection, fresh cadaver dissection and in situ sectional anatomy revealed that: (i) the CL did not contain the PSN; (ii) a well-defined fascial structure existed in the bottom or dorsal margin of the CL area; and (iii) the pelvic plexus was separated from vascular components of the CL. The present results provide a new perspective for nerve-sparing radical hysterectomy with extensive lateral parametrial dissection of the CL.
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References
Averette HE, Hguyen HN, Donato D et al. (1993) Radical hysterectomy for early invasive cervical cancer: a 25-year prospective experience with the Miami technique. Cancer 71, 1422–37.
Bannister LH (1995) Alimentary system. In: Gray’s Anatomy, 38th edn (Williams, PL, ed.). Churchill Livingstone, London, 1782.
Bazot M, Deligne L, Boudghène F et al. (1998) Anatomic approch to the parametrium: value of computed tomographic in vitro study compared to dissection. Surg Radiol Anat 20, 123–7.
Butler-Manuel SA, Buttery LDK, A’Hern RP, Polak JM, Barton DPJ (2000) Pelvic nerve plexus trauma at radical hysterectomy and simple hysterectomy: the nerve content of the uterine supporting ligaments. Cancer 89, 834–41.
DeBlok S (1982a) The connective tissue of the female pelvic region. A dissectional analysis. Acta Morphol Neerl Scand 20, 191–212.
DeBlok S (1982b) The connective tissue of the female pelvic region. A microscopical analysis. Acta Morphol Neerl Scand 20, 325–46.
DeBlok S (1982c) Histological aspects of connective tissue septa in the adult female pelvic region. Acta Morphol Neerl Scand 20, 363–77.
Ferner H (1964) Atlas of Topographical and Applied Human Anatony: Thorax, Abdomen and Extremities. Vol 2, WB SaundersPhiladelphia.
Fritsch H, Hötzinger H (1995) Tomographical anatomy of the pelvis, visceral pelvic connective tissue and its components. Surg Radiol Anat 8, 17–24.
Fröhlich B, Hötzinger H, Fritsch H (1997) Tomographical anatomy of the pelvis, pelvic floor, and related structures. Surg Radiol Anat 10, 223–30.
Honma M, Murakami G, Sato TJ, Namiki A (2000) Spread of injectate by C6 stellate ganglion block and fascial arrangement in the prevertebral region: an experimental study using donated cadavers. Reg Anesth Pain Med 25, 573–83.
Kobayashi T (1961) [Abdominal Radical Hysterectomy with Pelvic Lymphadenectomy for Cancer of the Cervix.] Nanzando, Tokyo. (In Japanese).
Latzko W, Schiffmann J (1919) Klinisches und anatomisches des zur radikaloperation des gebarmutterkrebses. Zbl Gynak 43, 715–9.
Lee YN, Wang KL, Lin MH et al. (1989) Radical hysterectomy with pelvic lymph node dissection for treatment of cervical cancer: a clinical review of 954 cases. Gynecol Oncol 35, 135–42.
Masubuchi K, Tenjin Y, Kubo H, Kimura M (1969) Five-year cure rate for carcinoma of the cervix uteri. Am J Obstet Gynecol 103, 566–73.
Munten V (1999) The surgical anatomy of the fasciae and the fascial spaces related to the rectum. Surg Radiol Anat 21, 319–24.
Nakajima F, Murakami G, Ohyama S, Horiguchi T, Sakakura Y, Yajima T (2001) Potential fascial dome made by the upper leaf of the phrenico-esophageal membrane. Okajimas Folia Anat Jpn 77, 201–10.
Nakano R (1981) Abdominal radical hysterectomy and bilateral pelvic lymph node dissections for cancer of the cervix. Gynecol Obstet Investig 12, 281–93.
Ogino K (1950) Modified Okabayashi method by Ogino. Surgery 4, 4–7.
Okabayashi H (1921) Radical hysterectomy for cancer of the cervix uteri. Surg Gynecol Obstet 33, 335–43.
Okabayashi H (1928) Abdominale systematische Panhysterectomie für Karzinom des Uterus. Jpn J Obstet Gynecol 11, 136–56.
Sakamoto S, Takizawa K (1988) An improved radical hysterectomy with fewer urological complications and with no loss of therapeutic results for invasive cervical cancer. Ballières Clin Obstet Gynecol 2, 953–62.
Sato K (1997) [Lymphatics of the ovary and uterus.] In: Color Atlas of Human Regional Lymphatics: an Anatomical Basis for Cancer Surgery (Sato T, ed.). Nankodo, Tokyo, 133–43. (In Japanese).
Taguchi K, Tsukamoto T, Murakami G (1999) Anatomical studies of the autonomic nervous system in the human pelvis by the whole-mount staining method: left-right communicating nerves between bilateral pelvic plexuses. J Urol 161, 320–5.
Toldt C (1903) Toldt Anatomischer Atlas, 3rd edn. Urban and Schwarzenberg, Berlin.
Trimbos JB, Maas CP, Deruiter MC, Peters AAW, Kenter GG (2001) A nerve-sparing radical hysterectomy: Guidelines and feasibility in Western patients. Int J Gynecol Cancer 11, 180–6.
Webb MJ (1994) Manual of Pelvic Surgery. Springer Verlag, Berlin.
Yabuki Y, Asamoto A, Hoshiba T, Nishimoto H, Kitamura S (1991) Dissection of the cardinal ligament in radical hysterectomy for cervical cancer with emphasis on the lateral ligament. Am J Obstet Gynecol 164, 7–14.
Yabuki Y, Asamoto A, Hoshiba T, Nishimoto H, Nishikawa Y, Nakajima T (2000) Radical hysterectomy: an anatomic evaluation of parametrial dissection. Gynecol Oncol 77, 155–63.
Yabuki Y, Asamoto A, Hoshiba T, Nishimoto H, Satoh N (1996) A new proposal for radical hysterectomy. Gynecol Oncol 62, 370–8.
Yagi H (1955) Extended abdominal hysterectomy with pelvic lymphadenectomy for carcinoma of the cervix. Am J Obstet Gynecol 69, 33–47.
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Kato, T., Murakami, G. & Yabuki, Y. Does the cardinal ligament of the uterus contain a nerve that should be preserved in radical hysterectomy?. Anato Sci Int 77, 161–168 (2002). https://doi.org/10.1046/j.0022-7722.2002.00023.x
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DOI: https://doi.org/10.1046/j.0022-7722.2002.00023.x