Surgical female pelvic anatomy
- Matthew D Barber, MD, MHS
Matthew D Barber, MD, MHS
- Professor of Surgery and Vice Chair of Clinical Resarch
- Obstetrics, Gynecology and Women's Health Institute
- Cleveland Clinic
- Amy J Park, MD
Amy J Park, MD
- Assistant Professor
- Departments of Obstetrics & Gynecology and Urology
- Georgetown University
Pelvic surgery requires a comprehensive knowledge of the pelvic anatomy to safely attain access, maximize exposure, ensure hemostasis, and avoid injury to viscera, blood vessels, and nerves.
The anatomy of the female genital tract and lower urinary and gastrointestinal tracts relevant to the surgeon performing laparotomy or laparoscopy, with an emphasis on clinical relevance and avoiding potential complications, is reviewed here. Surgical pelvic anatomy from a vaginal approach and the surgical anatomy of the anterior abdominal wall are discussed separately. (See "Surgical female urogenital anatomy" and "Anatomy of the abdominal wall".)
Anatomic features that are clinically applicable to female pelvic surgery are indented and bulleted throughout the text.
GENITAL TRACT VISCERA
The female upper genital tract consists of the cervix, uterine corpus, fallopian tubes, and ovaries. A sagittal view of the female pelvis is shown in the figure (figure 1).
The anatomy of the lower genital tract, comprised of the vulva and vagina, is discussed separately. (See "Surgical female urogenital anatomy", section on 'Lower genital tract'.)
- Lindeque BG. Management of cervical premalignant lesions. Best Pract Res Clin Obstet Gynaecol 2005; 19:545.
- Ramanah R, Berger MB, Parratte BM, DeLancey JO. Anatomy and histology of apical support: a literature review concerning cardinal and uterosacral ligaments. Int Urogynecol J 2012; 23:1483.
- DeLancey JO. Anatomic aspects of vaginal eversion after hysterectomy. Am J Obstet Gynecol 1992; 166:1717.
- Baggish MS. Intra-abdominal pelvic anatomy. In: Atlas of Pelvic Anatomy and Gynecologic Surgery, 2nd ed, Baggish MS, Karram MM. (Eds), Saunders Elsevier, Philadelphia 2006. p.117.
- Kumar V, Abbas AK, Fausto N, et al. Robbins and Cotran Pathologic Basis of Disease, Professional Edition, 8th ed, Saunders, Philadelphia 2009.
- Baggish MS. Introduction to pelvic anatomy. In: Atlas of Pelvic Anatomy and Gynecologic Surgery, 3rd ed, Baggish MS, Karram MM. (Eds), Elsevier Saunders, St. Louis 2011. p.5.
- Hurd WW, Bude RO, DeLancey JO, Newman JS. The location of abdominal wall blood vessels in relationship to abdominal landmarks apparent at laparoscopy. Am J Obstet Gynecol 1994; 171:642.
- Balzer KM, Witte H, Recknagel S, et al. Anatomic guidelines for the prevention of abdominal wall hematoma induced by trocar placement. Surg Radiol Anat 1999; 21:87.
- Richardson AC. The rectovaginal septum revisited: its relationship to rectocele and its importance in rectocele repair. Clin Obstet Gynecol 1993; 36:976.
- Wang Y, Zhao S. Placental blood circulation. In: Vascular biology of the placenta, Morgan & Claypool Life Sciences, San Rafael, CA 2010.
- Rock JA, Jone HW. Te Linde's Operative Gynecology, 9th ed, Lippincott, Philadelphia 2003.
- Gynecologic Oncology Group Surgical Procedures Manual, Revised January 2010.
- Vaginal surgery, 4th, Nichols DH, Randall CL (Eds), Lippincott Williams & Wilkins, Philadelphia 1996.
- SURGICAL PEARLS
- GENITAL TRACT VISCERA
- - Uterine corpus
- - Uterine cervix
- - Uterine support structures
- Uterosacral and cardinal ligament complex
- Round ligaments
- Broad ligament
- Endopelvic fascia
- - Ovary
- - Fallopian tube
- Common and external iliac vessels
- Inferior and superficial epigastric vessels
- Anterior and posterior divisions of the internal iliac artery
- Blood supply to the uterus, tubes, and ovaries
- Obturator lymph nodes
- Internal iliac lymph nodes
- External iliac lymph nodes
- Superficial inguinal lymph nodes
- Paraaortic lymph nodes
- Lymphatic drainage of the pelvic viscera
- - Uterus and proximal vagina
- - Ovary
- - Distal vagina and vulva
- Aortic plexus
- Superior and inferior hypogastric plexi
- Lumbosacral plexus
- Nerves of the anterior abdominal wall
- LOWER URINARY TRACT
- SIGMOID COLON, RECTUM, AND ANUS
- AVASCULAR PLANES
- Anterior and posterior cul-de-sacs
- Vesicovaginal space
- Retropubic space
- Paravesical space
- Pararectal space
- Rectovaginal space