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Abstract
Introduction/Background To evaluate the pelvic anatomical structures identified during radical hysterectomy (RH).
Methodology 105 consecutive RH cases, 64 Type B, 33 Type C1 and 8 Type C2 selective nerve-sparing, performed by single surgeon (gynecologic cancer surgeon and anatomist) for various gynecologic cancer cases between October 2020 and December 2023 were retrospectively analyzed from the prospectively documented operation notes, photos and videos.
Results Mainly there are two retroperitoneal spaces in the pelvis, the pararectal and paravesical. Dissection of retroperitoneal structures, obliterated umbilical artery at the paravesical space, ureter at the pararectal space and paravaginal zone, provides artificial cleavage planes, however they can not be termed as a space. Similarly, there is only fascia and septum between the vagina-rectum or bladder. There is no suspensory cardinal ligament, the laterally lying tissue from the cervix is formed by the parauterine and paracervix tissue. That has vascular, lymphatic and autonomic nerve components, from superior to inferior. The only suspensory tissue for the uterus is the attachment between the upper vagina and parietal fascia covering the sacrum at Sacral3–4 level. This ligament lies inferior to the rectouterine peritoneal fold, and rectum attaches to this sacrovaginal ligament from the medial part. The rectouterine tissue with the suspensory ligamentous structure was historically called uterosacral ligament. The sacrovaginal ligament does not have vascular, or neural components and the inferior hypogastric plexus (IHP) is found lateral to it. The hypogastric nerve and pelvic splanchnic nerves run at the lateral and medial part of the pararectal space, respectively. The vesical nerves arising from the IHP lie paravaginally inferolateral to the distal ureter and uretero-vesical junction. The hypogastric nerve plate lies at the infraureteric area close to the pelvic parietal fascia.
Conclusion The retroperitoneum has a dissection bias because of the subperitoneal membranous areolar tissue. That arises many misnomers and misunderstandings.
Disclosures None.
