Liposuction-assisted nerve-sparing extended radical hysterectomy: Oncologic rationale, surgical anatomy, and feasibility study☆,☆☆,★,★★
Section snippets
MRI
Scans were performed on a Siemens Expert 1.0 T Magnetom (Siemens, Erlangen, Germany). A T2-weighted turbo spin echo sequence was used in transverse and sagittal orientation. A T1-weighted spin echo sequence was used in transverse orientation and repeated after administration of contrast agent. Additionally a turbo spin echo sequence with fat suppression was used in coronal orientation. This sequence was optionally repeated in a sagittal orientation. The total time of data acquisition was about
MRI studies
The sectional anatomy of the parametrial tissues was studied with pelvic MRI series of patients without gynecologic pathology. Sections 5 mm thick around the ischial spine clearly demonstrated a bilateral triangular zone of adipose tissue between the mesorectum (lower border), uterovaginal venous plexus (upper border), and obturator internus, coccygeus, iliococcygeus muscle (lateral border), designated perispinous adipose tissue (Fig. 1, A).
Comment
According to the concepts of surgical oncology, radical treatment involves the wide en bloc resection of the tumor-bearing organ along with its primary lymphatic drainage compartment. The relevance of this principle has been recently reappraised with total mesorectal excision techniques for the surgical treatment of rectal cancer.9, 10 For the operative therapy of cervical cancer, radical hysterectomy adheres to the same oncologic principle, resection of the uterus en bloc with the parametria.
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Twenty-first century radical hysterectomy – Journey from descriptive to practical anatomy
2020, Gynecologic Oncology ReportsCitation Excerpt :At this point the author had the impression that TMMR resembled L&S method. In addition, Höckel et al. (1998) must have thoroughly cleared the surrounding tissues of the vaginal vein by liposuction. These surgical procedures deviate from the boundary of descriptive anatomy.
Standardized terminology of apical structures in the female pelvis based on a structured medical literature review
2020, American Journal of Obstetrics and GynecologyCurrent concepts and practical techniques of nerve-sparing laparoscopic radical hysterectomy
2016, European Journal of Obstetrics and Gynecology and Reproductive BiologyShort and long-term urodynamic and quality of life assessment after nerve sparing radical hysterectomy: A prospective pilot study
2016, European Journal of Obstetrics and Gynecology and Reproductive BiologyAnatomical consideration for the technique of nerve-sparing during radical hysterectomy for cervical cancer
2016, Gynecologie Obstetrique et Fertilite
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From the Departments of Obstetrics and Gynecology,a Anatomy,b and Radiology,c University of Mainz.
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Supported by a grant from Else Kröner-Fresenius-Stiftung to M.H.
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Reprint requests: Michael Höckel, MD, PhD, University of Mainz Medical School, Langenbeckstraße 1, 55101 Mainz, Germany
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