and Kentaro Sekiyama2
Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
Department of Obstetrics and Gynecology, Kitano Hospital, Kita-ku, Osaka, Japan
KeywordsAnatomy of the posterior (dorsal) leaf of the vesicouterine ligamentParavaginal spaceParacolpium (vaginal blood vessels)Isolation of the vaginal wallWertheim’s radical hysterectomyOkabayashi’s radical hysterectomyMeigs’ radical hysterectomyPiver type III
5.1 Novel Points of the Okabayashi’s Radical Hysterectomy
5.1.1 Clarification of the Anatomy of the Paravaginal Space Between the Posterior (Dorsal) Leaf of the Vesicouterine Ligament and the Paracolpium
In the tissue of the paracervix, Okabayashi found a loose connective tissue space. The space is named as Okabayashi’s paravaginal space (Figure 5.1a, b). By insinuation of scissors into the space, the paracervix is separated into the posterior (dorsal) leaf of the vesicouterine ligament and the vaginal blood vessels (paracolpium).
Recently, our clarification of the posterior (dorsal) leaf of the vesicouterine ligament revealed that at least two to three venous blood vessels from the dorsal side of the urinary bladder run in the posterior leaf of the vesicouterine ligament and drain into the deep uterine vein in the cardinal ligament (Figures 5.1b and 5.2a, b).