Radical Hysterectomy: An Anatomic Evaluation of Parametrial Dissection

The clinical significance of poor bladder compliance

“…Diverse etiologies have been reported to explain PC in previous studies; the decrease of blood flow to the bladder, 20,21 or bilateral injury of the pelvic nerve plexus. 22,23 The decrease of vascular flow might be due to a vascular injury after surgery in the pelvic cavity or the failure of vascular flow due to injury of the autonomic nervous system in the pelvis.…”

Laparoscopic identification of pelvic nerves in patients with deep infiltrating endometriosis

“…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].…”

Lymphatic vessels around the uterus: D2-40 (podoplandin) immunohistochemistry using elderly cadavers

“…This vascular sheath was quite different from a loose, laminar or fascial structures surrounding the LVs from the bladder and rectum. The tight vascular sheath appeared to be absent in the so-called vesico-uterine ligament, which has been one of the important targets of dissection in radical hysterectomy, especially in Japan [4,33]. LVs in the female pelvis, especially around the uterus, seemed unlikely to be involved in active drainage because they lacked valves and smooth muscle in contrast to the tight sheath.…”

“…However, the first surgical priority in patients with cervical cancer should be minimizing the possibility of failure to remove isolated paracervical neoplastic foci. Therefore, nerve-sparing radical hysterectomy [5,33] seems to offer the most effective balance between oncological safety and surgery-related complications, and would be particularly useful in selected patients such as those with early-stage disease but a high risk of paracervical involvement. Robotic lymphadenectomy including skeletonisation of the artery and vein has been tried at several hospitals for gastric cancer Figure 1B (an 80-year-old woman), displays lymphatic vessels (arrows) along a vein draining to the external surface of the bladder; B.…”