Gynecological Anatomy and Surgical Treatment

Study Notes

Removing the ovaries (BSO) can be necessary for patients with a BRCA mutation.
When an ovary is densely adhered to the pelvic side wall, the best way to excise it is by using a surgical approach that minimizes disruption to the surrounding tissues.

The ureters are tubes that carry urine from the kidneys to the bladder.
They have a lining of transitional epithelium and a thick muscular wall that allows for peristaltic action.
The blood supply to the ureters comes from multiple sources, including the renal arteries, gonadal arteries, and common iliac arteries.
The ureters are located behind the peritoneum and cross the pelvic brim at the sacroiliac joint.
Sympathetic nerves from T11-L2 supply the ureters.

It is important to carefully identify the ureters during surgery, as they are susceptible to injury.
Identifying the path of the ureters through the pelvis can help surgeons avoid injury.
Identifying the ureters before ligating the uterine vessels can also reduce the risk of injury.
If the ureters are not clearly visible, taking steps to ensure their integrity (such as placing a stent) is crucial.
Routine placement of ureteric stents does not guarantee ureteric protection during complex gynecological procedures.

the midline abdominal incision below the umbilicus passes through the skin, subcutaneous fat, membranous fascia, linea alba, transversalis fascia, and peritoneum, but does not enter the abdominal cavity.

It is vital to be aware of the abdominal and pelvic vasculature to avoid vascular injury during trocar placement in laparoscopic procedures.
Identifying the location of major vessels, carefully selecting trocar insertion sites, and using imaging techniques can help minimize the risk of vascular injury.

The abdominal aorta is a major blood vessel that supplies blood to the abdomen and lower limbs.
It enters the abdomen behind the diaphragm at the level of the 10th thoracic vertebra.
It bifurcates into the common iliac arteries at the level of the 4th lumbar vertebra.
The surface marking for the bifurcation of the abdominal aorta is approximately 2 cm below and to the right of the umbilicus.
The celiac artery arises from the abdominal aorta at the level of the 12th thoracic vertebra.
The renal arteries emerge from the abdominal aorta at the level of the 1st lumbar vertebra.

The inferior mesenteric artery (IMA) is a branch of the abdominal aorta that supplies blood to the left side of the colon.
The IMA is accompanied by the inferior mesenteric vein.
Before crossing the pelvic brim, it gives rise to the sigmoid artery.
The inferior mesenteric artery does not become the inferior rectal artery.

Anterior relations to the common iliac arteries include the ureter, the peritoneum, the superior rectal artery, and the superior hypogastric plexus.
The sympathetic trunk is located posterior to the common iliac arteries.

The internal iliac artery is a major blood vessel that supplies blood to the pelvis and lower limbs.
It divides into anterior and posterior divisions.
The anterior division gives rise to the following branches: obturator artery, internal pudendal artery, inferior gluteal artery, and middle rectal artery.
The inferior epigastric artery is a branch of the external iliac artery, not the internal iliac artery.
The posterior division gives rise to the following branches: iliolumbar artery and lateral sacral arteries.