Clinical anatomy of the subserous layer: An amalgamation of gross and clinical anatomy

Abstract

The 1998 edition of Terminologia Anatomica introduced some currently used clinical anatomical terms for the pelvic connective tissue or subserous layer. These innovations persuaded the present author to consider a format in which the clinical anatomical terms could be reconciled with those of gross anatomy and incorporated into a single anatomical glossary without contradiction or ambiguity. Specific studies on the subserous layer were undertaken on 79 Japanese women who had undergone surgery for uterine cervical cancer, and on 26 female cadavers that were dissected, 17 being formalin-fixed and 9 fresh. The results were as follows: (a) the subserous layer could be segmentalized by surgical dissection in the perpendicular, horizontal and sagittal planes; (b) the segmentalized subserous layer corresponded to 12 cubes, or ligaments, of minimal dimension that enabled the pelvic organs to be extirpated; (c) each ligament had a three-dimensional (3D) structure comprising craniocaudal, mediolateral, and dorsoventral directions vis-á-vis the pelvic axis; (d) these 3D-structured ligaments were encoded morphologically in order of decreasing length; and (e) using these codes, all the surgical procedures for 19th century to present-day radical hysterectomy could be expressed symbolically. The establishment of clinical anatomical terms, represented symbolically through coding as demonstrated in this article, could provide common ground for amalgamating clinical anatomy with gross anatomy. Consequently, terms in clinical anatomy and gross anatomy could be reconciled and compiled into a single anatomical glossary.