title: Neurovascular quantitative study of the uterosacral ligament related to nerve-sparing radical hysterectomy.
abstract: OBJECTIVE
  To analyze the distribution of autonomic nerves and blood and lymphatic vessels in the uterosacral ligament, elucidate detailed anatomy at a surgical level and provide pathobiological evidence for improvement of nerve-sparing radical hysterectomy.
  
  
  METHODS
  Surgical samples were collected from 15 patients who underwent radical hysterectomy for early stage cervical cancer (FIGO Ib1-IIa). Twenty-nine fresh specimens were divided into cervical, intermediate and sacral sections, and then subdivided into superficial and deep portions from the middle: the medial surface and lateral surface were also subdivided in order to analyze lymphatic vessels. The numbers of nerve branches in each section or portion of the section were analyzed. The lengths of the uterosacral ligaments were measured and immunohistochemistry staining was studied. Autonomic nerves, blood vessels and lymphatic vessels were quantitatively analyzed using image analysis software and biological stereology.
  
  
  RESULTS
  The volume density of sympathetic nerves in the deep portion was significantly higher than in the superficial portion (p<0.05), and the number of nerves was greatest in the cervical section (p<0.05). The volume density of blood vessels was not significantly different between the two portions (p>0.05) or among the three sections (p>0.05), and the volume density of the lymphatic vessels was greater in the medial surface (p<0.05), with most of them in the cervical section (p<0.05).
  
  
  CONCLUSIONS
  Our study provides systematic mapping of the location and distribution of autonomic nerve branches, blood vessels and lymphatic vessels in the uterosacral ligament.
authors.affiliation: Department of Obstetrics and Gynecology, Nan fang Hospital of Southern Medical University, Guangzhou, People's Republic of China.
authors.forename: Chunlin
authors.initials: C
authors.lastname: Chen
authors.affiliation: Department of Obstetrics and Gynecology, Nan fang Hospital of Southern Medical University, Guangzhou, People's Republic of China; Department of Obstetrics and Gynecology, The First Hospital of Changsha, Changsha, People's Republic of China.
authors.forename: Lei
authors.initials: L
authors.lastname: Huang
authors.affiliation: Department of Obstetrics and Gynecology, Nan fang Hospital of Southern Medical University, Guangzhou, People's Republic of China. Electronic address: lpivy@126.com.
authors.forename: Ping
authors.initials: P
authors.lastname: Liu
authors.affiliation: Department of Obstetrics and Gynecology, Nan fang Hospital of Southern Medical University, Guangzhou, People's Republic of China.
authors.forename: Guidong
authors.initials: G
authors.lastname: Su
authors.affiliation: Department of Obstetrics and Gynecology, Nan fang Hospital of Southern Medical University, Guangzhou, People's Republic of China.
authors.forename: Weili
authors.initials: W
authors.lastname: Li
authors.affiliation: Department of Obstetrics and Gynecology, Nan fang Hospital of Southern Medical University, Guangzhou, People's Republic of China.
authors.forename: Lin
authors.initials: L
authors.lastname: Lu
authors.affiliation: Department of Obstetrics and Gynecology, Nan fang Hospital of Southern Medical University, Guangzhou, People's Republic of China.
authors.forename: Liling
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Pathology, Nan fang Hospital of Southern Medical University, Guangzhou, People's Republic of China.
authors.forename: Xiangzhao
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Obstetrics and Gynecology, Nan fang Hospital of Southern Medical University, Guangzhou, People's Republic of China.
authors.forename: Hui
authors.initials: H
authors.lastname: Duan
authors.affiliation: Department of Obstetrics and Gynecology, University of Arizona, Arizona Cancer Center, Tucson, AZ, USA.
authors.forename: Changping
authors.initials: C
authors.lastname: Zou
authors.affiliation: Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, CT, USA; Tianjin Ameri-Chi Technology Co. Ltd., People's Republic of China.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Hatch
mesh_terms: D000290:Adnexa Uteri / Q000033:anatomy & histology*; D017776:Autonomic Pathways / Q000033:anatomy & histology*; D001808:Blood Vessels / Q000033:anatomy & histology*; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D007001:Hypogastric Plexus / Q000033:anatomy & histology; D007044:Hysterectomy / Q000379:methods*; D007091:Image Processing, Computer-Assisted; D007150:Immunohistochemistry; D042601:Lymphatic Vessels / Q000033:anatomy & histology*; D059351:Organ Sparing Treatments; D013153:Splanchnic Nerves / Q000033:anatomy & histology; D002583:Uterine Cervical Neoplasms / Q000601:surgery*; D014599:Uterus / Q000098:blood supply / Q000294:innervation*
keywords: Autonomic nerve; Biological stereology; Lymphatic vessels; Nerve-sparing radical hysterectomy; Uterosacral ligament