Discrepancies between classic anatomy and modern gynecologic surgery on pelvic connective tissue structure: Harmonization of those concepts by collaborative cadaver dissection

Objective The purpose of this study was to solve a disagreement regarding the anatomy of the pelvic connective tissue in 19th and 20th century, and to establish new surgical anatomy. Study design The study involved the dissection 26 female cadavers. The ligamentous structure of the pelvis was examined by developing the paravesical and pararectal spaces, using our standard procedure of radical hysterectomy. Results The lateral ligamentous structure of the pelvis was a plate complex, which consisted of the vesicohypogastric fascia, the transverse cervical ligament, and lateral ligament of the rectum. The 3-dimensional relationship of this complex and the pelvic organs was sagittaly perpendicular. The pelvic connective tissue was classified into 2 systems, musculofascial and mesentery-like structures. Conclusion The authors examined the discrepancies in 19th century anatomy for the pelvic connective tissue that is widely accepted in todayʹs medical field, therewith proposing a new surgical anatomy for this structure.