ORIGINAL COMMUNICATION Structure and Functional Significance of the Transverse Vesical Fold N.T. BOAZ, 1,2 * A.H. MARTIN, 3 K. THOMPSON, 3 C. FERREIRA, 4 AND L. FOREST-NEARN 5 1 Laboratory of Biological Anthropology and Anatomy, Integrative Centers for Science and Medicine, Martinsville, Virginia 2 Libyan International Medical University, Elkayrawn Street, Benghazi, Libya 3 Department of Anatomy, Ross University School of Medicine, Portsmouth, Commonwealth of Dominica 4 Princess Margaret Hospital, Goodwill, Roseau, Commonwealth of Dominica 5 7294 Joffa Circle, Warrenton, Virginia The plica vesicalis transversa or transverse vesical fold (TVF) is a peritoneal fold extending from the lateral side of the bladder to the side of the lesser pel- vis near the deep inguinal ring. It is an important landmark in laparoscopic surgery of the pelvis but is variably observed in the embalmed cadaver. We investigated the gross anatomy of this structure in the cadaver and confirmed that its medial portion corresponds to the location of the superior vesical artery(ies), thus supporting the idea that the TVF is ‘‘mesovesical.’’ However, no large vessels were observed grossly in the lateral portion of the TVF. The hypothesis that the lateral TVF has a suspensory function was tested histologi- cally by comparison with the suspensory ligament of the duodenum and the phrenicocolic ligament, both of which have smooth muscle contributing to their inferred suspensory function. Microscopic examination of prepared samples from 20 cadavers shows that the TVF evinces no smooth muscle in either its lateral or medial segments. The TVF is demonstrated to be a mesentery-like reflection of peritoneum raised by branches of the superior vesical artery which provides no demonstrable structural support for the bladder. Implications of these findings include avoidance of sectioning of medial TVF during laparoscopic surgery because of its vascular nature, and inadvisability of utilizing any portion of the TVF for an anchor in reconstruction of the anterior pelvic floor within the paravesical fossae. Clin. Anat. 24:62–69, 2011. V V C 2010 Wiley-Liss, Inc. Key words: superior vesical artery; pelvis; peritoneum; urinary bladder; laparoscopic surgery INTRODUCTION The plica vesicalis transversa or transverse vesical fold (TVF) is a salient structure seen during laparo- scopic visualization of the pelvis (Bloom et al., 1994) and is identified in the various editions of Nomina Anatomica and in its successor, Terminologia Ana- tomica (Federative Committee on Anatomical Termi- nology, 1998). Yet, standard anatomical texts and atlases afford it scant attention. The 10th edition of Grant’s Atlas of Anatomy (Agur et al., 1999) cor- rectly identifies and labels the TVF (although the 11th edition (Agur and Dalley, 2005) does not include this plate). The 7th edition of Rohen et al.’s Color Atlas of Anatomy (Rohen et al., 2010; p. 366) depicts the TVF in relation to branches of the supe- rior vesical artery but does not label the structure. The TVF, or at least its medial prolongation, is illus- *Correspondence to: Noel T. Boaz, Laboratory of Biological An- thropology and Anatomy, Integrative Centers for Science and Medicine, 12 Starling Avenue, Martinsville, VA 24112-2922. E-mail: noeltboaz@integrativemedsci.org Contract grant sponsor: Ross University School of Medicine Received 3 April 2010; Revised 16 July 2010; Accepted 11 August 2010 Published online 14 October 2010 in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/ca.21057 V V C 2010 Wiley-Liss, Inc. Clinical Anatomy 24:62–69 (2011)