Surgical Anatomical Structure of Uterine Artery Caudal Space for Robot-Assisted Extrafascial Hysterectomy With Ureterohypogastric Nerve Fascia Preservation: A Case Description

A surgical technique has been developed using a robot-assisted system to create the surgical anatomical structure of the uterine artery caudal space (UACS), a landmark for performing extrafascial hysterectomy, enabling a safe and easy parametrial resection to prevent ureteral injury and cervical sidewall bleeding at hysterectomy. UACS is created to preserve the ureterohypogastric nerve fascia (UHNF), which envelopes the ureter and the hypogastric nerve, and the vesicohypogastric fascia (VF), which wraps the uterine artery and veins. The boundaries of UACS are UHNF laterally, the uterine cervix medially, and VF cranially. VF is penetrated between UACS and the medial pararectal space under the uterine vessels and transected. We present a case of early-stage uterine cancer and describe the new surgical technique in detail, using UACS as a surgical landmark. This surgical technique could be applied not only to early-stage uterine cancer but also to benign uterine tumors using a robot-assisted surgical system.