Surgical anatomy of the pelvis: role of parametrium

Parametrium is a unique structure. Its definition has undergone significant changes throughout the evolution of concepts on the anatomy, embryology, and surgery of the pelvis. Knowledge of the parametrium anatomy is very important not only for surgeons dealing with the female reproductive system, but also for surgeons involved in the treatment of rectal cancer. For example, an outdated anatomical term “lateral ligaments of the rectum” is still widely used by gynecologic oncologists and is considered as a part of the parametrium. Combination surgeries for rectal cancer in women often involve the structures of parametrium. This paper reviews the history of studying the parametrium, its embryology, evolution of anatomical concepts, and their association with the development of pelvic surgery. We also propose allocating additional layers of the parametrium in order to make anatomical description closer to surgical practice.