Surgical female pelvic anatomy
- Matthew D Barber, MD, MHS
Matthew D Barber, MD, MHS
- Chair, Department of Obstetrics and Gynecology
- Professor of Obstetrics and Gynecology
- Duke University Medical Center
- 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'.)
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- 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