Fascial Anatomy and Its Relevance in Safe Laparoscopic Hysterectomy

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• 作者：Shailesh P. Puntambekar ; MS ; ^{shase63@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Seema P. Puntambekar ; MS ; Yamini Gadkari ; DNB ; Suyash Naval ; DNB
• 关键词：Anatomy ; Hysterectomy ; Fascia
• 刊名：Journal of Minimally Invasive Gynecology
• 出版年：2015
• 出版时间：November-December 2015
• 年：2015
• 卷：22
• 期：7
• 页码：1137
• 全文大小：401 K

文摘

To demonstrate the importance of being familiar with the anatomy of the endopelvic fascia as seen by laparoscopy to perform safe laparoscopic hysterectomies.

Design

Combination of surgical videos and design diagrams.

Setting

Compiled high-definition surgical videos from the Galaxy Care Laparoscopy Institute, Pune, India. These videos clearly demonstrate the anatomy of the endopelvic fascia and describe tips to avoid damage to the major structures, including the major vessels, ureter, bowel, bladder, and endopelvic fascia. The laparoscopic view of the anatomy with the current camera system is an excellent tool to demonstrate and teach pelvic anatomy, which can be applied to surgical principles in difficult benign and oncological cases.

Intervention

We used a total laparoscopic approach to demonstrate the fasciae that were seen during various types of hysterectomies. The video shows the following: (1) the posterior leaf of the broad ligament was opened until it reached the apex of the uterosacral ligament; (2) the anterior leaf of broad ligament was opened until it reached the vesico-uterine peritoneal reflection; (3) the principles of bladder dissection; (4) the pubocervico-vesical fascia and its relevance to bladder dissection; (5) the relevance of the anatomy of the uterine artery, vein, and ureter with endopelvic fascia within the leaves of the broad ligament; (6) Denonvillier's fascia dissection technique for dissection of the rectum away from the vagina; (7) the anatomy of the vesicocervical ligaments, forming the ureteric tunnel; (8) the dissection principles of lateralizing the ureter in the retrovesical region; (9) the endopelvic fascia reflection, which continued caudally, covering the pelvic floor; and (10) the relevance of the anatomy of the endopelvic fascia and the stress urinary incontinence treatment technique.

Conclusion

Understanding the anatomy of the fasciae of the pelvis helps to create avascular planes and is crucial for performing safe hysterectomies.