A Reinterpretation of Paracolpium in Radical Hysterectomy: New Insights into Its Surgical Implication

Abstract

Objective

To reinterpret the surgical anatomy of paracolpium in radical hysterectomy and to explore its implications for the surgery.

Setting

The term “paracolpium” first defined by Fothergill in 1907, is essential in radical hysterectomy. However, several challenges remain unresolved. These include: (1) inconsistent terminology in relation to its defined attributes; (2) the lack of consensus on anatomical landmarks; (3) unclear associations with the cardinal and sacral ligaments; and (4) the critical implications and requirements of paracolpium resection in radical hysterectomy practices.

Participants

A patient in her 60s diagnosed with stage IB2 cervical cancer was enrolled in a clinical trial and assigned to the laparoscopic surgery group. A step-by-step, narrated video demonstration.

Interventions

During the procedure, post-excision of the uterosacral, cardinal, and vesicovaginal ligaments, we identified a ligament-like structure situated between the middle third of the vagina and the pelvic wall. We have termed this structure the “paracolpium ligament.” A detailed anatomical description was performed, outlining its crucial attachments:

 • Medial attachment: middle third of the vagina

 • Lateral attachment: tendinous arch of the pelvic fascia (TAPF)

 • Cranial attachment: cardinal-uterosacral ligaments confluence

 • Caudal attachment: pubococcygeus muscle fascia

 • Dorsal: paravaginal space

 • Ventral: pararectal space

To ensure a safe dissection, the paracolpium ligament was exposed by removing anterior and posterior fat tissue. The extent of surgical resection was adapted based on the tumor's location. Extensive resection of the paracolpium ligament was essential when the tumor was localized to one side of the vagina to ensure complete removal of the disease; otherwise, preservation of the ligament was considered feasible.

Conclusion

In this video, we meticulously name and define the “paracolpium ligament,” providing groundbreaking insights into its anatomical and surgical implications in radical hysterectomy. Our findings contribute to a better understanding of surgical anatomy for cervical cancer.