臨床医学ジャーナル

概要

Cardinal Ligament and Transverse Cervical Ligament are not Synonymous

Yoshihiko Yabuki and Hiroaki Takagi

The cardinal ligament and transverse cervical ligament are not distinguished as separate entities in Terminologia Anatomica. This interpretation of the cardinal ligament as being synonymous with the transverse cervical ligament has had a profound influence on clinical anatomy and, consequently, on the operative procedures for cervical cancer. This prompted the author to investigate and analyze the differences between the two lateral parametria. This was carried out through research on the history of clinical anatomy and surgery for cervical cancer, together with data from the author’s surgical procedures for radical hysterectomy and cadaver dissections. An analysis by the author of Savage’s theory (1875), Clark’s surgery and Wertheim’s surgery yielded evidence of the cardinal ligament being referred to as the medial parametrium of the ureter. Moreover, from analysis of Mackenrodt’s theory, Latzko’s surgery and Okabayashi’s surgery, the transverse cervical ligament was found to be the lateral parametrium extending the cardinal ligament to the pelvic sidewall. However, in actual clinical practice the transverse cervical ligament is an artifact that can be excavated perpendicularly toward the sacral aspect and isolated between the paravesical and pararectal spaces. Therefore, a large discrepancy became apparent between theory and clinical anatomical evidence. Because of these contradictions, no consistency could be found for gross and clinical anatomical terms to coexist in one anatomical glossary. However, from morphological findings on the retroperitoneal space it allowed the author to find a common ground between the two anatomies. From a number of findings on the subserous layer, the author came to the following conclusion that the cardinal ligament was a bundle parallel to the uterus on the medial aspect of the ureter, and the transverse cervical ligament a bundle perpendicular to the uterus and connected to the pelvic sidewall.