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Nerve-Sparing Surgery in Cervical Carcinoma 461

Figure 12. (A). Separation and division of the rectovaginal ligament to obtain vaginal length deemed appropriate by the level of cervi-
cal disease, excluding the T-shaped inferior hypogastric plexus (B). Blood vessels of the paracolpium are ligated at the designated level

Figure 13. (A). Division of the paracolpium (B). Division of the paracolpium creates the situation that the uterus is only connected with
the vagina. After the confirmation of the length of the vaginal cuff, the vagina is incised and the uterus is amputated from the vagina.

10: Division of The Rectovaginal Ligament and on the opposite side, the length of the vaginal cuff is
Ligation of The Paracolpium confirmed. Then the uterus is amputated from the vagina
(Figure 13 A, B).
By pushing the rectum up, the rectovaginal ligament rises
to the surface between the T-shaped inferior hypogastric Conclusion
plexus and the rectum. Only the rectovaginal ligament is
divided using bipolar scissors toward the upper vagina If the surgeon can perform separation of the posterior
excluding the T-shaped nerve plane. By the division of leaf of the vesicouterine ligament, and could trace
the rectovaginal ligament close to the upper vagina, the the cross-shaped inferior hypogastric plexus, we can
bladder branch from the inferior hypogastric plexus successfully divide only the uterine branch from
forming T-shaped nerve plane is gradually separated the inferior hypogastric plexus. By these operative
from the blood vessels of the paracolpium (Figure procedures, the T-shaped inferior hypogastric plexus,
12A). The separation and division of the rectovaginal is able to be preserved and we can archive the urinary
ligament is extended caudally to obtain vaginal length functions of complete voiding, a sense of fullness and a
deemed appropriate by the level of cervical disease. At sense of micturition.
the designated level, the blood vessels of the paracolpium
are ligated (Figure 12B). Now, the T-shaped nerve plane References
formed by the hypogastric nerve, the pelvic splanchnic
nerve and the bladder branch of the inferior hypogastric 1. Wertheim E. Die erweiterte abdominale Operation bei
nerve is completely preserved. Carcinoma colli Uteri (auf Grund von 500 Fallen), Urban &
Schwarzenberg, Berlin (1911).
11: Extirpation of The Uterus
2. Okabayashi H. Radical abdominal hysterectomy for cancer
By the division of the paracolpium, the uterus is only of the cervix uteri, modification of the Takayama operation,
connected with the vagina. After the same procedure Surg. Gynecol. Obstet. 1921;33: 335–41.