Laparoscopic

Retroperitoneal Anatomy
in
Gynaecologic Surgery
 Superficial intraperiotoneal
anatomy
Landmark of anterior abdominal wall
• Inferior epigastric artery
• Medial umbilical ligament/obliterated
umbilical artery
• Median umbilical ligament/urachus
 Pelvic brim
Superficial
• Pelvic peritoneum
• Ovarian vessels in the infundibulopelvic
ligament
• Ureters
• Bifurcation of common iliac artery and
common iliac vein
 Deeper
• Medial edge of psoas muscle
• Obturator nerve
• Lumbosacral trunk
Pelvic side wall
First layer prietal peritoneum with ureter attached to it
Second layer consists of internal iliac vs with visceral
branches- uterine,superior vesical,inferior vesical,vaginal and
middle rectal arteries
Third layer
• psoas muscle
• External iliac artery and vein
• Obturator internus muscle with its nerve and vs coursing
towards obturator canal
 Avascular spaces
• Prevesical space of Retzius
• Paravesical space
• Pararectal space
• Vesicovaginal space
• Rectovaginal space
• Presacral space
 Applied anatomy of space of
Retzius
Space is bounded anteriorly by transversalis fascia, urethra, paraurethral ligament and
bladder neck forms floor,Pubic symphysis ,superior pubic rami with coopers
ligament(pectineus ligament) represents inferior limit.

Management of stress urinary incontinence

Burch urethropexy
 post
hysterectomy
fixation of mesh
 Applied anatomy
• Fixation of posterior mesh (vault prolapse)
• Laparoscopic treatment of rectovaginal
septum adenomyosis/endometriosis
• Laparoscopic management of deep
endometriosis
• Radical hysterectomy for carcinoma cervix
Rresection of
endometriotic
deposits
 Applied anatomy
• Laparoscopic sling surgery
• promontofixation (post hysterectomy vault
prolapse)
Laparoscopic
radical
hysterectomy
 Lymphatic drainage
• Pelvic lymph nodes external pelvic nodes along ext iliac vs
• Obturator nodes in the obturator fossa
• Hypogastric nodes along hypogastric vs .up to the
bifurcation of common iliac artery
• Lumber lymph nodes(above,lateral and below aorta on Lt. and
inferior venacava on Rt.)
• Applied anatomy-laparoscopic radical
hysterectomy for early stage cervical cancer
• Surgical staging of carcinoma vulva,ovary and
endometrium.
 conclusion
Knowledge of the retroperitoneal anatomy is
essential to the success
in advanced gynecologic laparoscopic surgery.

The anatomical advantage of laparoscopy is a

wonderful tool
for progress in pelvic surgery.