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Consensus on the Gemelli terminology of surgical anatomy for radical hysterectomy
  1. Nicolò Bizzarri1,
  2. Manuel Maria Ianieri1,
  3. Andrea Rosati1,
  4. Luigi Pedone Anchora1,
  5. Carlo Ronsini1,2,
  6. Irene Ladisa1,3,
  7. Maria Cavinato4,
  8. Francesco Fanfani1,5,
  9. Anna Fagotti1,5,
  10. Giovanni Scambia1,5 and
  11. Denis Querleu1,6
  1. 1 UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
  2. 2 Department of Woman, Child, and General and Specialized Surgery, University of Campania Luigi Vanvitelli School of Medicine and Surgery, Napoli, Italy
  3. 3 Department of Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
  4. 4 Accademia delle Belle Arti, Napoli, Italy
  5. 5 Università Cattolica del Sacro Cuore, Rome, Italy
  6. 6 University of Strasbourg, Strasbourg, France
  1. Correspondence to Professor Denis Querleu, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome 00168, Italy; denis.querleu{at}


Objectives To report on a consensus survey of experts on a recently proposed simplified nomenclature of surgical anatomy of the female pelvis for radical hysterectomy. The aim was to standardize surgical reports in clinical practice and understanding of the techniques in future surgical literature.

Methods The anatomical definitions were included in 12 original images taken at the time of cadaver dissections. Denomination of the corresponding anatomical structures was based on the nomenclature recently proposed by the same team. A three step modified Delphi method was used to establish consensus. After a first round of online survey, the legends of the images were amended to respond to the comments of the experts. Second and third rounds were performed. Consensus was defined as a yes vote to each question regarding the images provided, and 75% was defined as the cut-off for agreement. Comments justifying the no votes were taken into account to amend the set of images and legends.

Results A group of 32 international experts from all continents was convened. Consensus exceeded 90% for all five images documenting the surgical spaces. Consensus ranged between 81.3% and 96.9% for the six images documenting the ligamentous structures surrounding the cervix. Finally, consensus was lowest (75%) for the most recently defined denomination of the broad ligament (lymphovascular parauterine tissue or upper lymphatic pathway).

Conclusion Simplified anatomic nomenclature is a robust tool to describe the surgical spaces of the female pelvis. The simplified definition of ligamentous structures reached a high level of consensus, even if the terms paracervix (instead of lateral parametrium), uterosacral ligament (replaced by rectovaginal ligament), vesicovaginal ligament, and lymphovascular parauterine tissue remain matters of debate.

  • gynecologic surgical procedures
  • surgical procedures, operative
  • surgical oncology
  • hysterectomy

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  • Contributors Conceptualization: DQ. Methodology: all authors. Writing—original draft preparation: DQ. Writing—review and editing: all authors. Internal funding acquisition: GS. All authors have read and agreed to the published version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.