Key anatomies of DeLancey's three levels of vaginal support theory: an observation in laparoscopic surgery.
- Author:
Xiaofeng ZHAO
1
;
Gongli CHEN
2
;
Ling LEI
3
;
Xiaomei WU
4
;
Shikai LIU
5
;
Juntao WANG
6
;
Bin HU
7
;
Weiguo LYU
8
Author Information
1. Department of Gynecology, Zhejiang Provincial People's Hospital, Hangzhou 310014, China.
2. Department of Obstetrics & Gynecology, Southwest Hospital, the First Hospital Affiliated to Army Medical University, Chongqing 400038, China.
3. Department of Gynecology, People's Hospital of Anshun City, Anshun 561000, Guizhou Province, China.
4. Department of Gynecology, the First People's Hospital of Yunnan Province, Kunming 650034, China.
5. Department of Gynecology, Cangzhou Central Hospital, Cangzhou 061000, Hebei Province, China.
6. Department of Obstetrics & Gynecology, Longdongbao Campus of the First People's Hospital of Guiyang, Guiyang 550005, China.
7. Department of Gynecology, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450014, China.
8. Center for Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province, Department of Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China.
- Publication Type:Journal Article
- MeSH:
Female;
Humans;
Laparoscopy;
Ligaments;
anatomy & histology;
Pelvic Floor;
Urinary Bladder;
Vagina;
anatomy & histology;
surgery
- From:
Journal of Zhejiang University. Medical sciences
2018;47(4):329-337
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE:To observe and verify the key anatomies of DeLancey's three levels of vaginal support theory through laparoscopic surgery by space dissection technique.
METHODS:The features and stress performance of related anatomies were observed and analyzed in laparoscopic type C hysterectomy and pelvic lymphadenectomy for cervical cancer by natural space exposures.
RESULTS:The main ligament-like structure at level Ⅰ was the uterosacral ligament, which acted as the main apical fixation in the sacral direction, while the cardinal ligament was mainly composed of vascular system, lymph-vessels and loose connective tissue around them, lacking the tough connective tissue structures, which was connected to the internal iliac vascular system. There were no strong ligaments connected to the tendinous arch of pelvic fascia (ATFP) at the lateral side of vaginal wall at level Ⅱ. ATFP was the edge of the superior fascia of pelvic diaphragm, which was bounded by the fascia of the obturator. Its surface was smooth and close to the levator ani muscle and fuses with the vaginal fascia in about one thirds of middle lower segments of the vagina. When the ureter tunnel is separated, dense connective structures can be found in both anterior and posterior walls near the intersection of the ureter across uterine artery, fixing the bilateral angle of the bladder triangle, starting from the cervix and vagina and ending in the tunica muscularis vesicae urinariae.
CONCLUSIONS:Based on the laparoscopic anatomy, the pelvic floor fascia ligament support above the levator ani muscle can be considered mainly around the vagina, and fascial ligament above the levator ani muscle can be simply considered as two parallel planes forming a "double hammock" structure, which may provide more anatomic data for pelvic floor reconstruction.
