Top

Published in:

01-05-2019 | Cervical Cancer | Gynecologic Oncology

Neurovascular and lymphatic vessels distribution in uterine ligaments based on a 3D reconstruction of histological study: to determine the optimal plane for nerve-sparing radical hysterectomy

Authors: Pengfei Li, Hui Duan, Jun Wang, Shipeng Gong, Guidong Su, Jianyi Li, Lei Tang, Yan Zhang, Huijian Fan, Ping Liu, Chunlin Chen

Published in: Archives of Gynecology and Obstetrics | Issue 5/2019

Abstract

Objective

To present the distribution of neurovascular and lymphatic vessels in uterine ligaments using 3D models based on the pathological staining of serial 2D sections of postoperative specimens.

Methods

Serial transverse sections of fresh uterine ligaments from a patient with stage IB1 cervical squamous cell carcinoma were studied using the computer-assisted anatomic dissection (CAAD) technique. The sections were stained with hematoxylin and eosin, Weigert elastic fibers, D2-40 and immunostainings (sheep anti-tyrosine hydroxylase and rabbit anti-vasoactive intestinal peptide). The sections were then digitalized, registered and reconstructed three-dimensionally. Then, the 3D models were analyzed and measured.

Results

The 3D models of the neurovascular and lymphatic vessels in uterine ligaments were created, depicting their precise location and distribution. The vessels were primarily located in the upper part of the ligaments model, while the pelvic autonomic nerves were primarily in the lower part; the lymphatic vessels were scattered in the uterine ligaments, without obvious regularity.

Conclusion

CAAD is an effective anatomical method to study the precise distribution of neurovascular and lymphatic vessels in uterine ligaments. It can present detailed anatomical information about female pelvic autonomic innervation and the spatial relationship between nerves and vessels and may provide a better understanding of nerve-sparing radical hysterectomy.

Koh WJ, Abu-Rustum NR, Bean S, Bradley K, Campos SM, Cho KR, Chon HS, Chu C, Clark R, Cohn D, Crispens MA, Damast S, Dorigo O, Eifel PJ, Fisher CM, Frederick P, Gaffney DK, Han E, Huh WK, Lurain JR 3rd, Mariani A, Mutch D, Nagel C, Nekhlyudov L, Fader AN, Remmenga SW, Reynolds RK, Tillmanns T, Ueda S, Wyse E, Yashar CM, McMillian NR, Scavone JL (2019) Cervical cancer, version 3.2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 17:64–84. https://doi.org/10.6004/jnccn.2019.0001 CrossRefPubMed

van Gent MD, Romijn LM, van Santen KE, Trimbos JB, de Kroon CD (2016) Nerve-sparing radical hysterectomy versus conventional radical hysterectomy in early-stage cervical cancer. a systematic review and meta-analysis of survival and quality of life. Maturitas 94:30–38. https://doi.org/10.1016/j.maturitas.2016.08.005 CrossRefPubMed

Wang X, Chen C, Liu P, Li W, Wang L, Liu Y (2018) The morbidity of sexual dysfunction of 125 Chinese women following different types of radical hysterectomy for gynaecological malignancies. Arch Gynecol Obstet 297:459–466. https://doi.org/10.1007/s00404-017-4625-0 CrossRefPubMed

Balaya V, Rossi L, Cornou C, Ngô C, Bensaid C, Bats AS, Lecuru F (2017) Where does pelvic nerve injury occur during radical hysterectomy for cervical cancer? Gynecol Oncol 145:199–200CrossRef

Sakamoto S, Takizawa K (1988) An improved radical hysterectomy with fewer urological complications and with no loss of therapeutic results for invasive cervical cancer. Baillieres Clin Obstet Gynaecol 2:953–962CrossRef

Höckel M, Konerding MA, Peter Heuβel C (1998) Liposuction-assisted nerve-sparing extended radical hysterectomy: oncologic rationale, surgical anatomy, and feasibility study. Am J Obstet Gynecol 178:971–976. https://doi.org/10.1016/S0002-9378(98)70533-2 CrossRefPubMed

Höckel M, Horn LC, Hentschel B, Höckel S, Naumann G (2003) Total mesometrial resection: high resolution nerve-sparing radical hysterectomy based on developmentally defined surgical anatomy. Int J Gynecol Cancer 13:791–803. https://doi.org/10.1111/j.1525-1438.2003.13608.x CrossRefPubMed

Aoun F, van Velthoven R (2015) Lower urinary tract dysfunction after nerve-sparing radical hysterectomy. Int Urogynecol J 26:947–957. https://doi.org/10.1007/s00192-014-2574-8 CrossRefPubMed

Kavallaris A, Hornemann A, Chalvatzas N, Luedders D, Diedrich K, Bohlmann MK (2010) Laparoscopic nerve-sparing radical hysterectomy: description of the technique and patients' outcome. Gynecol Oncol 119:198–201. https://doi.org/10.1016/j.ygyno.2010.07.020 CrossRefPubMed

10.

van Gent MD, van den Haak LW, Gaarenstroom KN, Peters AA, van Poelgeest MI, Trimbos JB, de Kroon CD (2014) Nerve-sparing radical abdominal trachelectomy versus nerve-sparing radical hysterectomy in early-stage (FIGO IA2-IB) cervical cancer: a comparative study on feasibility and outcome. Int J Gynecol Cancer 24:735–743. https://doi.org/10.1097/IGC.0000000000000114 CrossRefPubMed

11.

Kim HS, Kim TH, Suh DH, Kim SY, Kim MA, Jeong CW, Hong KS, Song YS (2015) Success factors of laparoscopic nerve-sparing radical hysterectomy for preserving bladder function in patients with cervical cancer: a protocol-based prospective cohort study. Ann Surg Oncol 22:1987–1995. https://doi.org/10.1245/s10434-014-4197-1 CrossRefPubMed

12.

Chen C, Huang L, Liu P, Su G, Li W, Lu L, Wang L, Li X, Duan H, Zou C, Hatch K (2014) Neurovascular quantitative study of the uterosacral ligament related to nerve-sparing radical hysterectomy. Eur J Obstet Gynecol Reprod Biol 172:74–79. https://doi.org/10.1016/j.ejogrb.2013.09.035 CrossRefPubMed

13.

Butler-Manuel SA, Buttery LD, A'Hern RP, Polak JM, Barton DP (2000) Pelvic nerve plexus trauma at radical hysterectomy and simple hysterectomy: the nerve content of the uterine supporting ligaments. Cancer 89:834–841. https://doi.org/10.1002/1097-0142(20000815)89:4%3c834:AID-CNCR14%3e3.0.CO;2-7 CrossRefPubMed

14.

Kato T, Murakami G, Yabuki Y (2003) A new perspective on nerve-sparing radical hysterectomy: nerve topography and over-preservation of the cardinal ligament. Jpn J Clin Oncol 33:589–591CrossRefPubMed

15.

Kraima AC, Derks M, Smit NN, van de Velde CJ, Kenter GG, DeRuiter MC (2016) Careful dissection of the distal ureter is highly important in nerve-sparing radical pelvic surgery: a 3D reconstruction and immunohistochemical characterization of the vesical plexus. Int J Gynecol Cancer 26:959–966. https://doi.org/10.1097/IGC.0000000000000709 CrossRefPubMed

16.

Moszkowicz D, Alsaid B, Bessede T, Penna C, Benoit G, Peschaud F (2011) Female pelvic autonomic neuroanatomy based on conventional macroscopic and computer-assisted anatomic dissections. Surg Radiol Anat 33:397–404. https://doi.org/10.1007/s00276-010-0773-7 CrossRefPubMed

17.

Bertrand MM, Alsaid B, Droupy S, Benoit G, Prudhomme M (2013) Optimal plane for nerve sparing total mesorectal excision, immunohistological study and 3D reconstruction: an embryological study. Colorectal Dis 15:1521–1528. https://doi.org/10.1111/codi.12459 CrossRefPubMed

18.

Kimmig R, Aktas B, Buderath P, Rusch P, Heubner M (2016) Intraoperative navigation in robotically assisted compartmental surgery of uterine cancer by visualisation of embryologically derived lymphatic networks with indocyanine-green (ICG). J Surg Oncol 113: 554–559. https://doi.org/10.1002/jso.24174 CrossRefPubMedPubMedCentral

19.

Bertrand MM, Macri F, Mazars R, Droupy S, Beregi JP, Prudhomme M (2014) MRI-based 3D pelvic autonomous innervation: a first step towards image-guided pelvic surgery. Eur Radiol 24:1989–1997. https://doi.org/10.1007/s00330-014-3211-0 CrossRefPubMed

20.

Moszkowicz D, Alsaid B, Bessede T, Zaitouna M, Penna C, Benoit G, Peschaud F (2011) Neural supply to the clitoris: immunohistochemical study with three-dimensional reconstruction of cavernous nerve, spongious nerve, and dorsal clitoris nerve in human fetus. J Sex Med 8:1112–1122. https://doi.org/10.1111/j.1743-6109.2010.02182.x CrossRefPubMed

21.

Li P, Liu P, Chen C, Duan H, Qiao W, Ognami OH (2018) The 3D reconstructions of female pelvic autonomic nerves and their related organs based on MRI: a first step towards neuronavigation during nerve-sparing radical hysterectomy. Eur Radiol. https://doi.org/10.1007/s00330-018-5453-8 CrossRefPubMedPubMedCentral

22.

Thomeer MG, Gerestein C, Spronk S, van Doorn HC, van der Ham E, Hunink MG (2013) Clinical examination versus magnetic resonance imaging in the pretreatment staging of cervical carcinoma: systematic review and meta-analysis. Eur Radiol 23:2005–2018. https://doi.org/10.1007/10.1007/s00330-013-2783-4 CrossRefPubMed

23.

Park JJ, Kim CK, Park SY, Park BK (2015) Parametrial invasion in cervical cancer: fused T2-weighted imaging and high-b-value diffusion-weighted imaging with background body signal suppression at 3 T. Radiology 274:734–741. https://doi.org/10.1148/radiol.14140920 CrossRefPubMed

Title: Neurovascular and lymphatic vessels distribution in uterine ligaments based on a 3D reconstruction of histological study: to determine the optimal plane for nerve-sparing radical hysterectomy
Authors: Pengfei Li
Hui Duan
Jun Wang
Shipeng Gong
Guidong Su
Jianyi Li
Lei Tang
Yan Zhang
Huijian Fan
Ping Liu
Chunlin Chen
Publication date: 01-05-2019
Publisher: Springer Berlin Heidelberg
Keywords: Cervical Cancer
Cervical Cancer
Hysterectomy
Published in: Archives of Gynecology and Obstetrics / Issue 5/2019
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-019-05108-w

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Neurovascular and lymphatic vessels distribution in uterine ligaments based on a 3D reconstruction of histological study: to determine the optimal plane for nerve-sparing radical hysterectomy

Abstract

Objective

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2019

Compare two different usages of FRD for detecting high-grade cervical lesions and invasive cancer

Follicle-stimulating hormone promoted pyruvate kinase isozyme type M2-induced glycolysis and proliferation of ovarian cancer cells

Long-term effects of prenatal exposure to metformin on the health of children based on follow-up studies of randomized controlled trials: a systematic review and meta-analysis

Analysis of the reproductive outcomes and the size of the unicornuate uterus measured by magnetic resonance imaging and their relationship

The impact of repetitive oocyte retrieval on the ovarian reserve: a retrospective cohort study

Influence of androgen levels on conception probability in patients undergoing fertility treatment: a retrospective cohort study