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International Urogynecology Journal

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01-02-2014 | Original Article

Cardinal ligament surgical anatomy: cardinal points at hysterectomy

Authors: Andrew Samaan, Dzung Vu, Bernard T. Haylen, Kelly Tse

Published in: International Urogynecology Journal | Issue 2/2014

Abstract

Introduction and hypothesis

The cardinal ligament (CL) still requires more precise anatomical mapping. We aim to elucidate the anatomy of the CL and the roles it plays in gynecological surgery.

Methods

Studies employed sharp dissection of 28 formalin-fixed cadaveric hemipelves and 10 unembalmed cadaveric hemipelves.

Results

The CL (total length averaging 10.0 cm) can be subdivided into three sections: a distal (cervical) section, on average 2.1 cm long, attached to the lateral aspect of the cervix (posteriorly, it was confluent with the attachment of the uterosacral [USL] ligament to form the cardinal–uterosacral confluence [CUSC]); an intermediate section, on average 3.4 cm long, running laterally (slightly posteriorly) from the cervix; a proximal (pelvic) section, relatively thick, triangular-shaped on cross-section, averaging 4.6 cm long, attached to the lateral pelvic sidewall, with its apex at the first branching of the internal iliac artery. Only the distal section is free of any significant neural or vascular component (ureter is in the intermediate section) and therefore safe for surgical use. The CUSC (first pedicle of a vaginal hysterectomy and later pedicle of an abdominal hysterectomy), if attached to the vaginal vault at hysterectomy has the potential for both lateral (CL) and supero-posterior (USL) surgical support. This pedicle would not be subsequently accessible for other surgeries.

Conclusions

Suggested cardinal points at hysterectomy are: know the CL anatomy; the distal section (as part of the CUSC) can provide vaginal vault support; the intermediate and proximal sections are surgically dangerous.

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Title: Cardinal ligament surgical anatomy: cardinal points at hysterectomy
Authors: Andrew Samaan
Dzung Vu
Bernard T. Haylen
Kelly Tse
Publication date: 01-02-2014
Publisher: Springer London
Published in: International Urogynecology Journal / Issue 2/2014
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-013-2248-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Cardinal ligament surgical anatomy: cardinal points at hysterectomy

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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