A New Proposal for Radical Hysterectomy

Yabuki, Yoshihiko; Asamoto, A; Hoshiba, Tsutomu; Nishimoto, Hideaki; Satou, Naoaki

doi:10.1006/gyno.1996.0251

Cited by 93 publications

(75 citation statements)

References 2 publications

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“…The pedicle was also identified as a mesentery-like structure between the parietal and visceral structures, such as the levator ani and bladder. Actually, Yabuki (Yabuki et al 1996) demonstrated that a surgically identified deep layer of the VUL is composed of the vesical veins and nerves. In contrast, we did not find any distinct fascial structures corresponding with the superficial layer of the VUL because the area around the most distal part of the ureter was loose except for the so-called meso-ureter communicating between ureter and cervix.…”

Section: Discussionmentioning

confidence: 99%

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

Niikura

Katahira

Utsunomiya

et al. 2007

Tohoku J. Exp. Med.

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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-

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Section: Discussionmentioning

confidence: 99%

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

Niikura

Katahira

Utsunomiya

et al. 2007

Tohoku J. Exp. Med.

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“…Nerve sparing surgery has been suggested to decrease the side effects of the radical treatment of cervical cancer [8,[14][15][16][19][20][21][22]. Although the anatomy of the autonomic and sensitive nerves is not fully described, most authors suggest that there are different pathways for sensory, autonomous sympathetic, and parasympathetic nerves [10,15].…”

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confidence: 99%

Laparoscopic identification of pelvic nerves in patients with deep infiltrating endometriosis

2004

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“…Yabuki et al insisted that the neural pathway of the vesical nerve plexus within the VUL could be subdivided into three branches (Yabuki et al, 1996). Mauroy et al demonstrated medial and lateral vesical branches of the IHP via cadaveric dissection (Mauroy et al, 2007b).…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic pelvic anatomy of nerve‐sparing radical hysterectomy

et al. 2010

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Many reports regarding nerve-sparing radical hysterectomy have been published. However, most reports have been based on systematic descriptions via laparotomy or cadaver dissection. The aim of this work was to describe the pelvic anatomy of nerve-sparing radical hysterectomy via laparoscopy, with specific focus on the inferior hypogastric plexus. This study is based on 125 patients with FIGO stage IB cervical cancer who had undergone laparoscopic nerve-sparing radical hysterectomies since 1999. The inferior hypogastric plexus was demonstrated via laparoscopy and was comprised of afferent fibers from the sacral root (S2, S3, and S4), sacral sympathetic ganglion, and hypogastric nerve, and efferent fibers forming its vesical, uterovaginal, and rectal branches. During the dissection of the posterior leaf of the vesicouterine ligament, various vesical veins were identified. If the cut edge of an inferior vesical vein was pulled medially with upward traction, the vesical branches of the inferior hypogastric plexus were exposed and these were divided into medial and lateral branches. The magnified view of laparoscopy made it possible to dissect nerves and vessels meticulously and to secure a clear resection margin during the dissection of the deep part of the cardinal ligament, uterosacral ligament, and posterior leaf of the vesicouterine ligament.

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A New Proposal for Radical Hysterectomy

Cited by 93 publications

References 2 publications

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

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

Laparoscopic identification of pelvic nerves in patients with deep infiltrating endometriosis

Laparoscopic pelvic anatomy of nerve‐sparing radical hysterectomy

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