Redefinition of the pelvic connective tissue: in situ histologic examination.

OBJECTIVES: : The objectives of this study were to find a common perspective in clinical and gross/systemic anatomy for the pelvic connective tissue (subperitoneal fascia) and to establish a new pelvic anatomy. METHODS: : The histologic sections from 5 fixed cadavers were obtained from a total of 17 fixed and 11 fresh cadavers. On the basis of our past surgical and research findings, the relationship between the pelvic organs and the pelvic connective tissue was observed from in situ histologic sections of the whole pelvis. RESULTS: : Subperitoneal fasciae, a term that is expressed in gross/systemic anatomy, were manifested as a 3-dimensional structure by a complex of "ligaments," as defined in clinical terminology. In the supine position, this structure consisted of the sagittal plane formed by the rectouterine ligament and vesicouterine ligament; the perpendicular plane by the vesicohypogastric fascia, transverse cervical ligament, and lateral rectal ligament; and the horizontal plane by the superior fascia of the levator ani muscle. CONCLUSIONS: : The ligaments were regarded as a compatible component of the subperitoneal fascia. Our anatomical concept of the pelvic connective tissue differed from that for classic clinical anatomy.