Fascial structures and autonomic nerves in the female pelvis: A study using macroscopic slices and their corresponding histology |
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Authors: | Mitsuharu?Tamakawa Email author" target="_blank">Gen?MurakamiEmail author Ken?Takashima Tomoyasu?Kato Masato?Hareyama |
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Institution: | Department of Radiology and;Department of Anatomy, Sapporo Medical University School of Medicine, Sapporo,;Division of General Surgery, Muroran Municipal Hospital, Muroran and;Division of Gynecologic Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan |
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Abstract: | We investigated the topographical anatomy of the pelvic fasciae and autonomic nerves using macroscopic slices of five decalcified
female pelves. The lateral aspect of the supravaginal cervix uteri and superior-most vagina issued abundant thick fiber bundles.
These visceral fibrous tissues extended dorsolaterally, joined another fibrous tissue from the rectum (the actual lateral
ligament of the rectum) and attached to the parietal fibrous tissues at and around the sciatic foramina (i.e. the sacrospinous
ligament, thick fasciae of the coccygeus and piriformis and dorsal end of the covering fascia of the levator ani). The inferior
or ventral vagina also issued thick fiber bundles communicating with the levator ani fascia. This connection between the vagina
and levator fascia, when stretched, seemed to provide a macroscopic morphology called the arcus tendineus fasciae pelvis.
The overall morphology of the visceroparietal fascial bridge exhibited a bilateral wing-like shape. The fascial bridge complex
was adjacent but dorso-inferior to the internal iliac vascular sheath and located slightly ventral to the pelvic splanchnic
nerve. However, the pelvic plexus and its peripheral branches were embedded in the fascial complex. The hypogastric nerve
ran along and beneath the uterosacral peritoneal fold, which did not contain thick fibrous tissue. During surgery, in combination
with the superficially located vascular sheath, the morphology of the visceroparietal fascial bridge and associated nerves
seemed to be artificially changed and developed into the so-called cardinal, uterosacral, uterovesical and/or rectal lateral
ligaments. The classical and original concepts of these pelvic fascial structures may need to be altered to adjust to these
surgical observations. |
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Keywords: | cardinal ligament of the uterus hypogastric nerve pelvic splanchnic nerve rectal lateral ligament uterosacral ligament |
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