Anatomy

Question 1

Describe the course of the inferior epigastric arteries. How can these be visualized during laparoscopy?

Answer 1

Arise from the external iliac artery
Course medial to round ligament
Run under lateral third of rectus muscles
Directly visualized using laparoscopy (cannot typically be seen from outside using transillumination)

Question 2

What are the tissues that make up the anterior rectus sheath above the arcuate line? Below the arcuate line?

Answer 2

Above the arcuate line - aponeuroses of external obliques, internal obliques, transversus abdominis
Below the arcuate line - aponeuroses of external obliques, internal obliques

Question 3

What structures are found in the median, medial, and lateral umbilical folds?

Answer 3

Median - urachus
Medial - obliterated umbilical arteries
Lateral - inferior epigastric vessels

Question 4

Describe the origin & insertion of the obturator internus muscle.

Answer 4

Origin - bony surfaces around obturator foramen
Insertion - greater trochanter of femur
(Passes through greater sciatic foramen)

Question 5

Describe the origin & insertion of the piriformis muscle. What neurologic structure lies on the surface of the piriformis?

Answer 5

Origin - sacrum lateral to anterior foramina
Insertion - greater trochanter of femur
(Passes through greater sciatic foramen)
Sacral plexus passes through greater sciatic foramen on the surface of the piriformis

Question 6

What are the three muscles that make up the levator ani?

Answer 6

Iliococcygeus
Pubococcygeus
Puborectalis

Question 7

List four common sites of ureteric injury at hysterectomy.

Answer 7

At or below IP ligament
At cardinal ligament, where ureter passes under uterine artery
Lateral border of uterosacral ligament
Where the ureter enters the base of the bladder (in close proximity to anterior vaginal wall)

Question 8

List the arteries arising from the anterior & posterior division of the internal iliac artery.

Answer 8

Anterior - uterine, obturator, vaginal, obliterated umbilical, superior vesical, inferior vesical, middle rectal, inferior gluteal, internal pudendal
Posterior - iliolumbar, lateral sacral, superior gluteal

Question 9

List four vertical pelvic anastomoses.

Answer 9

Ovarian - uterine
Superior rectal - middle rectal
Middle rectal - inferior rectal
Obturator - inferior epigastric
Inferior gluteal - circumflex & perforating branches deep femoral
Superior gluteal - lateral sacral
Lumbar - iliolumbar

Question 10

From what spinal levels do the following nerves arise?

Genitofemoral
Ilioinguinal
Femoral
Obturator

Answer 10

Genitofemoral - L1-2
Ilioinguinal - L1
Femoral - L2-4
Obturator - L2-4

Question 11

What are the boundaries of Hesselbach’s triangle? What is the clinical significance of this area?

Answer 11

Inferior boundary: inguinal ligament
Medial boundary: rectus muscle
Lateral boundary: inferior epigastric vessels

Direct inguinal hernias protrude through the abdominal wall in this area

Question 12

Which nerve may be injured by compression of the fibular head when the patient is in stirrups? How does this injury typically present?

Answer 12

Peroneal nerve

Foot drop

Question 13

Which nerve may be injured by a self-retaining retractor in a Pfannenstiel incision? What deficits would you expect to see? What is the prognosis of this injury?

Answer 13

Femoral nerve
Numbness/paresthesia of anterior thigh, anteromedial leg, medial foot
Quadriceps weakness, weak patellar reflex
Prognosis is excellent - most recover spontaneously