Fig. 4.

Anatomy of the lateral uterine ligament. Shown in A is a mock RH using a fresh cadaver. The vesicouterine, fourth, retroperitoneal and pararectal spaces are observed. The paravesical space is to be excavated within the dotted oval black circle. B is a schematic illustration of A. The paravesical space is developed, and the exposed anterior mesoureter is depicted. C denotes the structural component of the paracervix. The dotted red triangle denotes CL. D denotes the separated posterior leaf of VUL of Okabayashi. The superior vesical vein is seen to be transparent (Yabuki et al., 1996). E shows separation of the superior vesical vein and vesical nerve branch following excavation of the fourth space (Yabuki, 2019). a; uterus, b; bladder, f; ureter, g; uterine artery, h; deep uterine vein, k; vesicohypogastric fascia, l; TCL, m; lateral ligament of the rectum, n; Latzko’s pararectal space (upper portion), p; internal iliac vessels, q; paravesical space, r; CL, w; paracolpium, z; LUL, gg; vesicouterine space, hh; retroperitoneal space, ii; fourth space, jj; blader pillar (superficial layer of VUL), kk; anterior mesoureter, ll; posterior mesoureter, mm; superior fascia of the pelvic diaphragm, nn; superior vesical vein, oo; vesical nerve branch, yy; Okabayashi’s pararectal space.