The lateral infraureteral parametrium: myth or reality?

Area of Science:

• Gynecologic Oncology
• Surgical Anatomy
• Pelvic Anatomy

Background:

• The parametrium is a critical anatomical region in radical hysterectomy.
• Understanding parametrial structures is essential for oncologic surgery.
• Previous descriptions of the infraureteral parametrium lack detailed anatomical correlation.

Purpose of the Study:

• To delineate the surgical anatomy of the infraureteral parametrium.
• To clarify the anatomical structures encountered during radical hysterectomy.
• To evaluate the existence and characteristics of the infraureteral parametrium.

Main Methods:

• Laparoscopic dissections during 12 type III radical hysterectomies.
• Bilateral pelvic dissections of 10 fresh and embalmed female cadavers.
• Magnetic resonance imaging (MRI) of 10 healthy female controls.

Main Results:

• Two distinct anatomical entities were identified: lateral mesometrium and infraureteral parametrium.
• The lateral paracervix, classically described below the ureter, was not identified.
• The infraureteral parametrium was characterized as fibrous tissue near the rectum and pelvic plexus.

Conclusions:

• The study provides evidence for the absence of the infraureteral parametrium as previously described.
• These findings question the surgical relevance of current radical hysterectomy classifications.
• A redefinition of the concept of radical hysterectomy may be necessary based on anatomical findings.