Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
(2)
Department of Obstetrics and Gynecology, Kitano Hospital, Kita-ku, Osaka, Japan
Keywords
Anatomy 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).
Figure 5.1
Anatomical location of Okabayashi’s paravaginal space. (a) Anatomical location of the entrance of Okabayashi’s paravaginal space (a yellow color area surrounded by a blue line) in the posterior (dorsal) leaf of the vesicouterine ligament. (b) In the skeletonized view of the posterior (dorsal) leaf of the vesicouterine ligament from the lateral side of the cervix, the location of the paravaginal space is illustrated as a yellow band with two black arrow heads
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).
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