Radical Hysterectomy: An Anatomic Evaluation of Parametrial Dissection

Abstract Objectives. This study was designed to demonstrate a reduction in the amount of blood loss for vesicouterine ligament dissection and to investigate the intrapelvic autonomic nerve pathway and its preservation by means of anatomic analysis. Methods. The anchoring mechanism of the pelvic viscera to the pelvic wall was divided into a supporting system facing laterally and a suspensory system facing dorsoventrally. An operative procedure was designed in which both systems were separated and dissected independently. Results. Between the two systems, an artificial space was developed, which required a new dissection method for the parametrium and revealed a new anatomic pathway for the ureter and autonomic nerve. The amount of blood loss (mean ± SD) during dissection of the vesicouterine ligament was ultimately 260.1 ± 114.8 ml. Postoperatively, the maximum capacity of the bladder was 393.9 ± 40.4 ml, maximum detrusor pressure 6.3 ± 4.1 cm H 2 O, mean compliance >10 ml/cm H 2 O, residual urine 23.8 ± 9.4 ml, and maximum flow rate 25. ± 8 2.2 ml/s, respectively. Conclusion. A new classification for the parametrium and its dissection method have been established. Development of this new operative procedure has also contributed to a decrease in blood loss and preservation of bladder function.