Surgical Anatomical Structure of Uterine Artery Caudal Space for Robot-Assisted Extrafascial Hysterectomy With Ureterohypogastric Nerve Fascia Preservation: A Case Description

A surgical technique has been developed using a robot-assisted system to create the surgical anatomical structure of the uterine artery caudal space (UACS), a landmark for performing extrafascial hysterectomy, enabling a safe and easy parametrial resection to prevent ureteral injury and cervical sid...

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Published inCurēus (Palo Alto, CA) Vol. 16; no. 2; p. e54512
Main Authors Shimabukuro, Koji, Ichikawa, Maiko, Tsukada, Takafumi, Endo, Seiichi, Sakamoto, Masae
Format Journal Article
LanguageEnglish
Published United States Cureus Inc 20.02.2024
Cureus
Subjects
Anatomy
Bladder
Case reports
Cervix
Connective tissue
Dissection
Endometrial cancer
Endometriosis
Hysterectomy
Injuries
Laparoscopy
Ligaments
Magnetic resonance imaging
Obstetrics/Gynecology
Oncology
Robots
Surgical techniques
Tumors
Uterus
Veins & arteries
ureterohypogastric nerve fascia
vesicohyogastric fascia
robot-assisted surgery
uterine artery caudal space
extrafascial hysterectomy
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Summary:A surgical technique has been developed using a robot-assisted system to create the surgical anatomical structure of the uterine artery caudal space (UACS), a landmark for performing extrafascial hysterectomy, enabling a safe and easy parametrial resection to prevent ureteral injury and cervical sidewall bleeding at hysterectomy. UACS is created to preserve the ureterohypogastric nerve fascia (UHNF), which envelopes the ureter and the hypogastric nerve, and the vesicohypogastric fascia (VF), which wraps the uterine artery and veins. The boundaries of UACS are UHNF laterally, the uterine cervix medially, and VF cranially. VF is penetrated between UACS and the medial pararectal space under the uterine vessels and transected. We present a case of early-stage uterine cancer and describe the new surgical technique in detail, using UACS as a surgical landmark. This surgical technique could be applied not only to early-stage uterine cancer but also to benign uterine tumors using a robot-assisted surgical system.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.54512