Journal of minimally invasive gynecology · 2026
Demystifying Extrafascial and Intrafascial Hysterectomy.
СтатьяVideo-Audio MediaНазвание и аннотация: Перевод в очереди
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Fernandes Luiz Flávio Cordeiro, Amaral Alexandre Cosme do, Botchorishvili Revaz, Kemp Marta Maria
Аннотация
STUDY OBJECTIVE: To clarify the anatomical and technical distinctions between intra- and extrafascial hysterectomy in benign gynecologic surgery.
DESIGN: Educational video showing the practical differences between intra- and extrafascial approaches to benign hysterectomy.
SETTING: Video recordings of benign hysterectomies highlighting key features of the pelvic connective tissue (endopelvic fascia) to illustrate fascial planes relevant to each technique.
INTERVENTION: Understanding intra- and extrafascial hysterectomy requires familiarity with the endopelvic fascia-a connective tissue envelope surrounding all pelvic organs and condensing into the uterosacral and cardinal ligaments and the pericervical ring [1,2]. In intrafascial hysterectomy, these fascial structures are preserved, and the colpotomy is performed concentrically at the level of the pericervical ring [3]. In extrafascial hysterectomy, the colpotomy is created more laterally, resulting in disruption of the connective tissue and a more radical dissection [3]. Although extrafascial hysterectomy is well defined in oncologic procedures through levels of radicality, the benign gynecologic literature lacks a clear and concise explanation distinguishing intra- from extrafascial approaches. Existing anatomical descriptions of the pelvic fascia and related nomenclature are inconsistent and vary over time [1,2]. The few studies referencing the intra- vs extrafascial distinction do not present the concept in a simplified or surgically practical manner [3,4]. This study was approved by the Institutional Review Board of Hospital Beneficência Portuguesa de São Paulo, protocol 4.113.304.
CONCLUSION: The primary difference between intra- and extrafascial hysterectomy is whether the ligaments surrounding the cervix-the uterosacral and cardinal ligaments, along with the pericervical ring-are preserved intact or transected during the procedure.
DESIGN: Educational video showing the practical differences between intra- and extrafascial approaches to benign hysterectomy.
SETTING: Video recordings of benign hysterectomies highlighting key features of the pelvic connective tissue (endopelvic fascia) to illustrate fascial planes relevant to each technique.
INTERVENTION: Understanding intra- and extrafascial hysterectomy requires familiarity with the endopelvic fascia-a connective tissue envelope surrounding all pelvic organs and condensing into the uterosacral and cardinal ligaments and the pericervical ring [1,2]. In intrafascial hysterectomy, these fascial structures are preserved, and the colpotomy is performed concentrically at the level of the pericervical ring [3]. In extrafascial hysterectomy, the colpotomy is created more laterally, resulting in disruption of the connective tissue and a more radical dissection [3]. Although extrafascial hysterectomy is well defined in oncologic procedures through levels of radicality, the benign gynecologic literature lacks a clear and concise explanation distinguishing intra- from extrafascial approaches. Existing anatomical descriptions of the pelvic fascia and related nomenclature are inconsistent and vary over time [1,2]. The few studies referencing the intra- vs extrafascial distinction do not present the concept in a simplified or surgically practical manner [3,4]. This study was approved by the Institutional Review Board of Hospital Beneficência Portuguesa de São Paulo, protocol 4.113.304.
CONCLUSION: The primary difference between intra- and extrafascial hysterectomy is whether the ligaments surrounding the cervix-the uterosacral and cardinal ligaments, along with the pericervical ring-are preserved intact or transected during the procedure.