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
- 65 Downloads
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.
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.
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.
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.
KeywordsCervical cancer Nerve-sparing Pelvic autonomic nerves 3D reconstruction Histological examination
This study has received funding by the National Natural Science Fund of China (81571422, 81370736), the National Science and Technology Support Program of China (2014BAI05B03), the National Natural Science Fund of Guangdong (2015A030311024), the Science and Technology Plan of Guangzhou (158100075), and the Foundation from the President of Nanfang Hospital of Southern Medical University (2015C015).
PFL: protocol development, data collection and manuscript writing; HD: protocol development, data analysis and manuscript writing; JW: protocol development, data collection and manuscript writing; SPG: data analysis; GDS: data analysis; JYL: protocol development; LT: protocol development; YZ: protocol development; HJF: manuscript writing; PL: protocol development, data analysis and manuscript editing; CLC: protocol development, data analysis and manuscript editing.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from the participant included in the study.
- 1.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 CrossRefGoogle Scholar
- 2.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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar