Liposuction-assisted nerve-sparing extended radical hysterectomy: Oncologic rationale, surgical anatomy, and feasibility study☆,☆☆,★,★★
Section snippets
MRI
Scans were performed on a Siemens Expert 1.0 T Magnetom (Siemens, Erlangen, Germany). A T2-weighted turbo spin echo sequence was used in transverse and sagittal orientation. A T1-weighted spin echo sequence was used in transverse orientation and repeated after administration of contrast agent. Additionally a turbo spin echo sequence with fat suppression was used in coronal orientation. This sequence was optionally repeated in a sagittal orientation. The total time of data acquisition was about
MRI studies
The sectional anatomy of the parametrial tissues was studied with pelvic MRI series of patients without gynecologic pathology. Sections 5 mm thick around the ischial spine clearly demonstrated a bilateral triangular zone of adipose tissue between the mesorectum (lower border), uterovaginal venous plexus (upper border), and obturator internus, coccygeus, iliococcygeus muscle (lateral border), designated perispinous adipose tissue (Fig. 1, A).
Comment
According to the concepts of surgical oncology, radical treatment involves the wide en bloc resection of the tumor-bearing organ along with its primary lymphatic drainage compartment. The relevance of this principle has been recently reappraised with total mesorectal excision techniques for the surgical treatment of rectal cancer.9, 10 For the operative therapy of cervical cancer, radical hysterectomy adheres to the same oncologic principle, resection of the uterus en bloc with the parametria.
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Twenty-first century radical hysterectomy – Journey from descriptive to practical anatomy
2020, Gynecologic Oncology ReportsStandardized terminology of apical structures in the female pelvis based on a structured medical literature review
2020, American Journal of Obstetrics and GynecologyCitation Excerpt :Through group consensus, we have provided definitions, and propose their adoption as standard terms: “Vesicouterine ligament” was used in 26 citations from 10 countries (Netherlands, Japan, Spain, Belgium, Germany, Serbia, Austria, France, United States, China) from 1975 through 2014.16,19,37,38,40,41,42,43,45,47,52,54,55,57,69,74,77,83,84,85–87,89,103,104 This structure would be considered a connective tissue ventral extension of the cardinal ligament [A09.1.03.031] that attaches to the bladder [A08.3.01.001] and carries blood vessels, nerves, and the distal ureter [A08.2.01.001] (Figure 2).
Current concepts and practical techniques of nerve-sparing laparoscopic radical hysterectomy
2016, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :The concept of autonomic nerve-sparing radical hysterectomy (NSRH) was first proposed by Kobayahsi [3] in the 1960s and Sakamoto and Takizawa [4] in the 1980s and named the “Tokyo method”. Subsequent studies have suggested its feasibility and efficacy, proposing various technical issues to preserve pelvic nerves [16–24]. However, the complexity of pelvic anatomy, including vessels and autonomic nerves around the uterus and bladder and the insufficient visual representation of pelvic space in the field of abdominal surgery, has been a barrier to better understanding of nerve-sparing techniques.
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From the Departments of Obstetrics and Gynecology,a Anatomy,b and Radiology,c University of Mainz.
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Supported by a grant from Else Kröner-Fresenius-Stiftung to M.H.
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Reprint requests: Michael Höckel, MD, PhD, University of Mainz Medical School, Langenbeckstraße 1, 55101 Mainz, Germany
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