Laparoscopic Pelvic Anatomy in Females: Applied Surgical Principles

This book offers a concise and easy-to-understand overview of facts and concepts in pelvic anatomy.
Laparoscopy provides good vision in a limited field, which means that surgeons have to rely on their
anatomical knowledge of what structures lie in the vicinity and which structures need to be preserved.
Focusing on surgical anatomy, the book helps laparoscopic surgeons better understand the female pelvic
structures so improve their surgical skills.


1 Pelvic Organs 1

2 Pelvis Boundaries 9
2.1 Sacral Promontory 12
2.2 Concepts of the Blood Supply 16
2.3 Lateral Boundary 21
2.4 Caudal Boundary 22
2.5 Anterior Boundary 22

3 Ligaments and Supports of the Uterus 25
3.1 Uterosacral Ligaments 28
3.1.1 Concepts 31
3.1.2 Rules 36
3.2 Mackenrodt’s Ligaments 37
3.2.1 Rules 37
3.3 Paravaginal/Paracolpos 41
3.3.1 Rules 44
3.4 Round Ligaments 44
3.4.1 Rules 44
3.5 Broad Ligament 47

4 Bones and Muscles 51
4.1 Coccyges 51
4.2 Psoas Muscle 51
4.3 Bones57
4.4 Inferiorly Pubic Symphysis 57

5 Vascular Anatomy 59
5.1 Aorta/Vena Cava 64
5.2 External Iliac Artery and Vein 73
5.2.1 Important Aspects of Inferior Epigastric Artery and Vein 73
5.2.2 Internal Iliac Artery 81
5.2.3 Rules 103
5.3 Uterine Artery 106
5.3.1 Rules 112
5.4 Superior Vesical Artery 112
5.5 Obliterated Hypogastric Artery 116
5.5.1 Rules 116
5.5.2 Obturator Artery 119
5.5.3 Ovarian Artery 119
5.5.4 Ovarian Vein124
5.6 Veins128
5.6.1 Common Iliac Vein 128
5.6.2 Internal Iliac Vein 128
5.6.3 External Iliac Vein 139

6 The Spaces141
6.1 Pouch of Douglas or the Rectovaginal Space 141
6.2 Pararectal Space 145
6.3 Paravesical Space 151
6.4 Prevesical Space 154

7 Fascial Anatomy 163
7.1 Cervicovesical Fascia 163
7.2 Denonvilliers’ Fascia 163
7.3 Endopelvic Fascia 163
7.4 Waldeyer’s Fascia 163

8 Anatomy of the Ureter 183
8.1 Blood Supply 204

9 Nerves 209
9.1 The Genitofemoral Nerve 209
9.2 The Obturator Nerve 215
9.3 The Hypogastric Nerve 221
9.4 Pelvic Splanchnic Nerve 227
9.5 Sciatic Nerve 229

10 Lymphatics 231
10.1 Ilio-Obturator Nodes 235
10.2 Internal Iliac Nodes 244
10.3 Lumbosacral Chain 245
10.4 Para-aortic and Paracaval Nodes 246

11 Applications of Anatomy 255
11.1 Dissection of the Pararectal Space and Paravesical Space 255
11.2 Medial Pararectal Space 259
11.3 Exposure of the Retroperitoneum 260
11.3.1 The Lateral Approach 260
11.4 Radical Hysterectomy (Pune Technique) 263
11.5 Nerve Sparing 271
11.6 Hysterectomy Type I or Intrafascial 273

Suggested Reading 279

Contents