Precise anatomy of the vesico-uterine ligament for radical hysterectomy (original) (raw)
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Vascular Pedicle Lengths After Hysterectomy
Obstetrics & Gynecology, 2012
OBJECTIVE: To estimate uterine vessel lengths and diameters recovered at radical hysterectomy to assess prospects for direct vascular anastomosis bilaterally to the external iliacs in uterus transplantation, and thereby the feasibility of live uterus donation as a future treatment of absolute uterine factor infertility.
The Tohoku Journal of Experimental Medicine, 2007
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
Vaginal blood flow after radical hysterectomy with and without nerve sparing. A preliminary report
International Journal of Gynecological Cancer, 2008
Early stage cervical cancer; Quality of cancer care and Quality of life Leiden, 2007 Early stage cervical cancer; Quality of cancer care and Quality of life ISBN: 978-90-8559-300-3 Cover photography: Carla van de Puttelaar, Amsterdam Lay-out and print: Optima Grafi sche Communicatie B.V. Financial support for printing of this thesis was provided by: Stichting Nationaal Fonds tegen Kanker-voor onderzoek naar reguliere en alternatieve therapieën. J.E. Jurriaanse Stichting Sanofi Pasteur MSD N.V. Ortho-Biotec, divisie van Janssen-Cilaq B.V. Medical Dynamics Smiths medical Nederland B.V. Amgen B.V. Nycomed Nederland B.V. Early stage cervical cancer; Quality of cancer care and Quality of life Proefschrift ter verkrijging van de graad van Doctor aan de Universiteit Leiden, op gezag van de Rector Magnifi cus prof.mr. P.F. van der Heijden, volgens besluit van het College voor Promoties te verdedigen op
Surgical and Radiologic Anatomy, 2018
Objective In radical cystectomy, the surgeon generally ligates the umbilical artery at its origin. This artery may give rise to several arteries that supply the sexual organs. Our aim was to evaluate pelvic and perineal devascularisation in women after total cystectomy. Patients and methods We carried out a prospective anatomical and radiological study. We performed bilateral pelvic dissections of fresh adult female cadavers to identify the dividing branches of the umbilical artery. In parallel, we examined and compared the pre-and postoperative imaging investigations [magnetic resonance imaging (MRI) angiography] in patients undergoing cystectomy for benign disease to quantify the loss of pelvic vascularisation on the postoperative images by identifying the occluded arteries. Results The anatomical study together with the radiological study visualised 35 umbilical arteries (n = 70) with their branching patterns and collateral arteries. The uterine artery originated from the umbilical artery in more than 75% of cases (n = 54) of the internal pudendal artery in 34% (n = 24) and the vaginal artery in 43% (n = 30). The postoperative MRI angiograms showed pelvic devascularisation in four patients. Devascularisation was dependent on the level of surgical ligation. In the four patients with loss of pelvic vascular supply, the umbilical artery had been ligated at its origin. Conclusion The umbilical artery gives rise to various branches that supply the pelvis and perineum. If the surgeon ligates the umbilical artery at its origin during total cystectomy, there is a significant risk of pelvic and perineal devascularisation.
The Swift operation: a modification of the Leiden nerve-sparing radical hysterectomy
Gynecological Surgery, 2008
In 2002, our group introduced an operation to avoid damage to the pelvic autonomous nerves during radical hysterectomy that proved to be feasible, effective and safe. During the last five years, we have adapted our surgical technique to make this procedure easier and safer in terms of radicality. We report on the changes in the surgical approach and the results in the first 15 consecutive patients. The Swift operation is more radical in the area of the uterosacral ligaments than the original operation, and it dissects the hypogastric nerve free under direct vision. In the area of the parametria, it is more radical in the deep lateral part. The vascular parametrial tissue is dissected and separated ventrally from the ureters. From October 2006 to February 2007, 15 consecutive patients with cervical cancer stage IA2 to IB2 underwent the Swift operation. The extra operating time amounted to 20 min, which was similar to the original operation, and with no extra blood loss. The suprapubic catheter was removed after a median of five days. Up until now (February 2008), no recurrences have been seen in these patients. It was concluded that the Swift procedure is easy to perform and that it offers advantages over the original operation in terms of safety and radicality.
Unexpected encounters challenging modified radical hysterectomy
International Journal of Clinical Obstetrics and Gynaecology
The intention of this study is to educate and caution young surgeons about the possibility of stumbling into anatomical anomaly while operating for cancer cervix. Methods: This is an observational study, reflecting the numbers of congenital anomalies that were encountered while doing hysterectomy for cancer cervix in a tertiary care hospital within a 16 years span. Results: This study revealed the overall prevalence of congenital anomalies while performing hysterectomy for cancer cervix to be 2.9% and double ureter to be most common anomaly encounterd. Conclusion: Anatomical anomalies pose challenges when encountered while operating for cancer cervix. Surgical methods and dissections need to be planned accordingly to protect urinary pathways and vessels, that should be kept in mind particularly by low volume surgeons. Surgery can be disastrous if they is not recognized prior to procedure.