Surgical anatomy of the vaginal vault.

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Abstrakt

Tytuł:: Surgical anatomy of the vaginal vault.
Autorzy:: Haylen BT; Department of Gynaecology, University of New South Wales, Sydney, New South Wales, Australia.
Vu D; Department of Anatomy, University of Notre Dame, Sydney, New South Wales, Australia.
Źródło:: Neurourology and urodynamics [Neurourol Urodyn] 2022 Aug; Vol. 41 (6), pp. 1316-1322. Date of Electronic Publication: 2022 May 27.
Typ publikacji:: Journal Article; Review
Język:: English
Imprint Name(s):: Original Publication: New York : Alan R. Liss, c1982-
MeSH Terms:: Pelvic Organ Prolapse*/surgery
Vagina*/anatomy & histology
Vagina*/surgery
Cadaver ; Female ; Gynecologic Surgical Procedures ; Humans ; Ligaments/surgery ; Treatment Outcome ; Uterus
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Contributed Indexing:: Keywords: Level I Vagina; cysto-enterocele; pelvic organ prolapse; recto-enterocele; surgical anatomy; vaginal vault
Entry Date(s):: Date Created: 20220527 Date Completed: 20220727 Latest Revision: 20221015
Update Code:: 20240104
PubMed Central ID:: PMC9543804
DOI:: 10.1002/nau.24963
PMID:: 35620982
: Czasopismo naukowe

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Aim: Vaginal vault (VV) surgery should be a key part of surgery for a majority of pelvic organ prolapse (POP). The surgical anatomy of the VV, the upper most part of the vagina, has not been recently subject to a dedicated examination and description.
Methods: Cadaver studies were performed in (i) 10 unembalmed cadaveric pelves (observation); (ii) 2 unembalmed cadaveric pelves (dissection); (iii) 5 formalinized hemipelves (dissection). The structural outline and ligamentous supports of the VV were determined. Further confirmation of observations in post-hysterectomy patients were from a separate study on 300 consecutive POP repairs, 46% of whom had undergone prior hysterectomy.
Results: The VV is equivalent to the Level I section of the vagina, measured posteriorly from the top of the posterior vaginal wall (apex or highest part of the vagina) to 2.5 cm below this point. It comprises the anterior fornix (through which cervix protrudes or is removed at hysterectomy), posterior fornix and two lateral fornices. Before hysterectomy, the posterior aspects of the cervix and upper vagina are supported by the uterosacral (USL) and cardinal ligaments (CL), the distal segments of which fuse together to form a cardinal-uterosacral ligament complex (cardinal utero-sacral complex), around 2-3 cm long. Post---hysterectomy, there is some residual USL support to the anterior fornix but the posterior fornix has no ligamentous support and is thus more vulnerable to prolapse.
Conclusion: Effective management of VV prolapse will need to be part of most POP repairs. Enhanced understanding of the surgical anatomy of the vaginal vault allows more effective planning of those POP surgeries.
(© 2022 The Authors. Neurourology and Urodynamics published by Wiley Periodicals LLC.)

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