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Pelvic Anatomy from a Laparoscopic Perspective
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  1. Pelvic Anatomy from a Laparoscopic Perspective • Tommaso Falcone MD • Professor & Chairman • Cleveland Clinic Foundation

  2. Anatomy & Advanced Laparoscopic Surgery Course

  3. Anatomic Areas • Anterior abdominal wall • Pelvic sidewall • Extra-peritoneal spaces • Retropubic space • Presacral space • Pararectal space

  4. Anterior Abdominal Wall • Relationship of the vessels & nerves to potential entry sites for trocars

  5. Retroperitoneal Vessels & Umbilicus • Bifurcation of the aorta • thin patients at umbilicus • More caudad with increasing weight • Left common iliac vein • inferior to the bifurcation of the aorta • crosses the sacrum

  6. Left Upper Quadrant Insertion • 2-cm below the subcostal margin mid-clavicular line • Organs • Aorta-11 cm • Spleen-12cm • Stomach-4.4cm • Liver-4.0cm • Left kidney 13.2cm

  7. Laparoscopic view of the spleen • Spleen is far from the LUQ, unless splenomegaly is present

  8. Pelvic Sidewall Anatomy • 3 layers • Ureter • Branches of the int.iliac artery • Muscle & nerve

  9. Pelvic Sidewall: ureter • Pelvic brim • over the common or external iliac • under ovarian vessels • Courses anterior to the internal iliac • UNDER THE OVARY • 1.5 -2 CM LATERAL UTERO-SACRAL LIGAMENTS • Cervix • WITHIN 2CM

  10. Pelvic Sidewall: Blood vessels • Internal iliac artery • anterior & posterior division • Umbilical artery • obliterated • medial umbilical ligament • relationship to the uterine artery

  11. Pelvic Arteriogram

  12. Pelvic & Inguinal Nerves • Genito-femoral nerve • Femoral nerve

  13. Retropubic Space • Anterior • Pubic bone • Lateral • Obturator internus muscle, fasciae, neurovascular bundle • Posteriorly • bladder & pubocervical fasciae