Two lateral parametria in radical hysterectomy: History and outcome.

Aim: Some anatomic concepts for 20th century radical hysterectomy (RH) did not conform to progress in surgical technique. The purpose of this article was to put forward a new practical anatomy and application to surgical procedures.

Methods: Following a historical review the author reexamined his surgical procedures from 1980 to 2005 on 131 patients with cervical cancer. One hundred and eight of these patients had undergone RH and 23 super RH plus neoadjuvant chemotherapy, 7 had RH combined with a total mesorectal excision because of infiltration into the lateral rectal ligament due to rectal cancer. Also reviewed were data on surgical procedures and anatomy following a series of mock RH on 26 donated female cadavers.

Results: It was found that the cardinal ligament and transverse cervical ligament must be distinguished. The vesicohypogastric fascia, transverse cervical ligament, and lateral rectal ligament formed a continuum with their relationship to the organs being perpendicular. The surgical technique for an RH is total excision of the transverse cervical ligament, whereas the one for a semi-RH is partial or total excision of the deep uterine vein. The paracolpium is the caudal extension of the cardinal ligament, not the medial extension of the superior fascia of pelvic diaphragm.

Conclusion: New practical anatomy and surgical technique were established through recognition of morphology of the living body being transformed by surgical maneuvers.