Surgical anatomy of the uterosacral ligament.
OBJECTIVE
This study aims to elucidate and expand current knowledge of the uterosacral ligament (USL) from a surgical viewpoint.


METHODS
Studies were performed on 12 unembalmed cadaveric pelves and five formalin-fixed pelves.


RESULTS
The USL, 12-14-cm long, can be subdivided into three sections: (1) distal (2-3 cm), intermediate (5 cm), and proximal (5-6 cm). The thick (5-20 mm) distal section, attached to cervix and upper vagina, is confluent laterally with the cardinal ligament. The proximal section is diffuse in attachment and generally thinner. The relatively unattached intermediate section is wide, and thick, well defined when placed under tension, more than 2 cm from the ureter and suitable for surgical use. The strength of the USL is perhaps derived not only from the ligament itself, but also from the addition of extraperitoneal connective tissue.


CONCLUSIONS
The USL can be subdivided into three sections according to thickness and attachments with the intermediate section suitable for surgical use, particularly for vaginal vault support.
Vu
Dzung
D
School of Medical Sciences, University of New South Wales, Kensington, NSW, Australia.
Haylen
Bernard T
BT
Tse
Kelly
K
Farnsworth
Annabelle
A
D002102:Cadaver; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008022:Ligaments / Q000033:anatomy & histology* / Q000601:surgery; D012447:Sacrum / Q000033:anatomy & histology*; D014599:Uterus / Q000033:anatomy & histology* / Q000601:surgery; D014621:Vagina / Q000033:anatomy & histology* / Q000601:surgery
Int Urogynecol J Pelvic Floor Dysfunct. 2008 Oct;19(10):1393-8
18478174
Int J Gynecol Cancer. 2001 May-Jun;11(3):180-6
11437922
Am J Obstet Gynecol. 2005 Oct;193(4):1565-73
16202758
Am J Obstet Gynecol. 2005 Jul;193(1):7-15
16021052
Int Urogynecol J Pelvic Floor Dysfunct. 2008 Feb;19(2):283-92
17690831
Obstet Gynecol. 2001 Jun;97(6):873-9
11384688
Int Urogynecol J Pelvic Floor Dysfunct. 2006 Nov;17(6):642-5
16733625
Am J Obstet Gynecol. 2007 Dec;197(6):672.e1-6
18060977
Am J Obstet Gynecol. 2001 Dec;185(6):1339-42; discussion 1342-3
11744906
Cancer. 2000 Aug 15;89(4):834-41
10951347
Adv Anat Embryol Cell Biol. 2004;175:III-IX, 1-64
15152384
BJU Int. 2006 Feb;97(2):345-8
16430644
Am J Obstet Gynecol. 1950 Jan;59(1):1-12, illust
15399622
Int Urogynecol J. 2011 Jan;22(1):69-75
20740357
Crit Rev Oncol Hematol. 2003 Dec;48(3):271-9
14693339
Am J Obstet Gynecol. 1997 Dec;177(6):1337-43; discussion 1343-4
9423733
Int Urogynecol J Pelvic Floor Dysfunct. 2008 Nov;19(11):1565-70
18668191
Surg Radiol Anat. 1991;13(2):145-8
1925917
Am J Obstet Gynecol. 2000 Dec;183(6):1402-10; discussion 1410-1
11120503
Int Urogynecol J Pelvic Floor Dysfunct. 2009 Apr;20(4):427-34
19159055
Am J Obstet Gynecol. 2000 Dec;183(6):1365-73; discussion 1373-4
11120498
J Urol. 2003 May;169(5):1770-4
12686830
Reprod Sci. 2008 Jan;15(1):91-6
18212359
Obstet Gynecol. 1957 Dec;10(6):595-602
13484166
Obstet Gynecol. 2006 Aug;108(2):255-63
16880293
Obstet Gynecol. 2004 Mar;103(3):447-51
14990404