Fig. 5.

The structure of the paracolpium and its excision. Shown in A is excavation of the four spaces in the lateral parametrium and depiction of the related tissues. B shows a frontally sectioned HE stained tissue specimen of fairly tough anterior and posterior vaginal fasciae from the superior most part of the vagina. These fasciae merge on the lateral aspect of the vagina and connect, via denser connective tissue fiber, to the parietal endopelvic fascia or the superior fascia of the pelvic diaphragm. This denser connective tissue fiber is considered to be the tendinous arc of the pelvic fascia. The area surrounded by a dotted green line in B denotes the paracolpium. Double-headed red arrow in C indicates the area where the fourth space is created. D shows separation of the paracolpium following extension of the fourth space within which the Kelly forceps can be seen clamped. E denotes a tissue specimen taken from within the dotted white frame in D. a; uterus, b; bladder, c; rectum, d; uterine cervix, e; vagina, f; ureter, g; uterine artery, h; deep uterine vein, n; Latzko’s pararectal space, q; paravesical space, w; paracolpium, z; LUL, dd; hypogastric nerve, ii; fourth space, jj; bladder pillar, nn; superior vesical vein, oo; vesical nerve branch, pp; vaginal fascia, qq; parietal fascia, rr; obturator internus muscle, ss; vaginal muscle, tt; vaginal nerve plexus, xx; superior fascia of the pelvic diaphragm or deep investing fascia, yy; Okabayashi’s pararectal space, zz; pre-sacral parietal fascia of the pelvis.