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240 Nerve sparing radical hysterectomy; muallem technique with a precise explanation of parametrium and paracolpium
  1. M Muallem
  1. Charité medical university, Germany


Even when the radical hysterectomy, as standard therapy for locally invasive cervical cancer, has a long history began since more than a century by published monograph from Ernst Wertheim, many discrepancies still exist in the literature regarding terminology, anatomy and the technique of surgical dissection. The current anatomical description of radical hysterectomy is more concerned with the uterus and did not recognise the importance of vaginal cuff resection (1/3 to ½ of the vagina) and its paracolpium as an essential part of radical hysterectomy.

The dorsal parametrium is only the sacrouterine ligament, and the dorsal paracolpium is the sacrovaginal ligament.

Lateral paracolpium is the vaginal blood supply originated from (artery) and discharged into (vein) the internal iliac artery and vein beneath the ureter. In this way, we identify the ureter as a landmark splitting the now called lateral parametrium (cardinal ligament) to lateral parametrium above the ureter, which contains the uterine artery and vein, and to lateral paracolpium beneath the ureter and contains vaginal artery and vein. These both vessels were wrongly called from the Japanese colleagues as deep uterine vein. The ventral paracolpium is in this way nothing else than the deep layer of vesicouterine ligament and the superficial layer of the vesicouterine ligament is only the ventral parametrium. In the ventral paracolpium, we could identify 2 veins discharging in the vaginal vein and making vein anastomoses with branches from an inferior vesical vein. These are the lateral and the medial vaginovesical vein.

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