Does the cardinal ligament of the uterus contain a nerve that should be preserved in radical hysterectomy?

The cardinal ligament (CL) of the uterus is present as a specific part of the parametrium when the pararectal and paravesical spaces are developed surgically. According to usual nerve-sparing radical hysterectomy (the Tokyo method), the CL is divided into two parts, the vascular part for dissection and the nerve part that contains the pelvic splanchnic nerve (PSN) as a major target for nerve sparing. In contrast, we hypothesized that the CL and another structure outside of the usual area for surgical dissection, that is, the lateral rectal ligament, are mutually continuous and that the PSN runs through the lateral ligament rather than the CL. In the present study, a combination of routine dissection, fresh cadaver dissection and in situ sectional anatomy revealed that: (i) the CL did not contain the PSN; (ii) a well-defined fascial structure existed in the bottom or dorsal margin of the CL area; and (iii) the pelvic plexus was separated from vascular components of the CL. The present results provide a new perspective for nerve-sparing radical hysterectomy with extensive lateral parametrial dissection of the CL.