Related Experiment Video
Updated: Apr 19, 2026
Isolation and Characterization of the Murine Uterosacral Ligaments and Pelvic Floor Organs
Published on: March 3, 2023
Development of a novel classification system for anatomical variants of the puboprostatic ligaments with expert
Michael Kim1, Shawna L Boyle2, Alfonso Fernandez2
1Division of Clinical Anatomy, Department of Anatomy & Cell Biology, Western University, London, ON;
Introduction:
We propose a novel classification system with a validation study to help clinicians identify and typify commonly seen variants of the puboprostatic ligaments (PPL).
Methods:
A preliminary dissection of 6 male cadavers and a prospective dataset of over 300 robotic-assisted laparoscopic radical prostatectomies (RARP) recorded on video were used to identify 4 distinct ligament types. Then the prospectively collected database of surgical videos was used to isolate images of the PPL from RARP. Over 300 surgical videos were reviewed and classified with 1 to 5 pictures saved for reference of the type of PPL. To validate the new classification system, we selected 5 independent, blinded expert robotic surgeons to classify 100 ligaments based on morphology into a 4-type system: parallel, V-shaped, inverted V-shape, and fused. One week later, a subset of 25 photographs was sent to the same experts and classified. Statistical analyses were performed to determine both the intra-rater and inter-rater reliability of the proposed system.
Results:
Inverted V-shaped ligaments were noted most frequently (29.97%), parallel and V-shaped ligaments were found at 19.19% and 11.11%, respectively and fused ligaments were noted less frequently (6.06%). There was good intra-rater agreement (κ = 0.66) and inter-rater agreement (κ = 0.67) for the classification system.
Conclusions:
This classification system provided standardized descriptions of ligament variations that could be adopted universally to help clinicians categorize the variants. The system, validated by several blinded expert surgeons, demonstrated that surgeons were able to learn and correctly classify the variants. The system may be useful in helping to predict peri- and postoperative outcomes; however, this will require further study.
More Related Videos
Related Concept Videos
01:09Functional Classification of Joints
The functional classification of joints is determined by the amount of mobility between the adjacent bones. Joints are functionally classified as a synarthrosis or immobile joint, an amphiarthrosis or slightly moveable joint, or as a diarthrosis, a freely moveable joint. Fibrous and cartilaginous joints can be functionally classified as either synarthroses or amphiarthroses, whereas all synovial joints are classified as diarthroses.
Synarthrosis
An...
01:20Structural Classification of Joints
A fibrous joint is where the adjacent bones are united by fibrous connective...
01:19Anatomy of the Genitourinary System II: Bladder and Urethra
01:16Accessory Glands of the Male Reproductive System
The epididymis is a small, comma-shaped organ located at the back of each testicle. The epididymis can be divided into three main parts: the head, body, and tail. The head of the epididymis...
01:30Classification of Connective Tissues
Connective Tissue Proper
Connective tissue proper is the most abundant class of connective tissues. As its name implies, it predominantly connects different tissues in the body. Depending on the cell types, ground substance, viscosity, and fiber types in the ECM, connective tissue proper is further categorized into loose and dense....
01:11Anatomy of the Genitourinary System I: Kidneys and Ureters