Anatomy

Question 1

Ureter anatomy in pelvis

Answer 1

Enters at level of SI joint crossing bifurcation of the common iliac artery
At pelvic brim:
-moves lateral to medial
-lies inferior to IP on medial leaflet of broad ligament
-follows the anterior division of the internal iliac artery
Passes behind the lateral forbid of the vagina and under the uterine arteries
Passes obliquely through the bladder wall in the inferomedial direction

Average distance from cervix is 2 cm! One finger!

Question 2

Most common sites of urethral injury during hysterectomy

Answer 2

Pelvic side wall
Inferior to uterine vessels
Base of the IP
Pubocervical ligament/parametrium

Question 3

Superficial vessels at risk during laparscopy

Answer 3

Superficial epigastric arteries
(Branches of inguinal artery)
Often can trans-illuminate

Question 4

Deep vessels at risk of injury at laparoscopy

Answer 4

Inferior epigastric arteries
(Branch of external iliac)
Beneath lateral umbilical ligament
Located 4-8cm from the midline

Question 5

Median umbilical ligament

Answer 5

Remnant of the embryonic UTA his

Extends from the apex of the bladder to the umbilicus

Question 6

Medial umbilical ligament

Answer 6

Remnant of the fetal umbilical arteries

Question 7

Lateral umbilical ligament

Answer 7

Peritoneal fold overlies the inferior epigastric artery and accompanying veins

Question 8

Lateral trocar placement

Answer 8

2/3 distance between umbilicus and ASIS

Question 9

Structures around the sacral promontory

Answer 9

Bifurcation of common iliac vessels
Ureter crosses over bifurcation from lateral to medial
Entire vascular anatomy is lateral to pelvic ureter

Question 10

External iliac branches

Answer 10

Inferior epigastric
Deep circumflex iliac artery
Continues as the femoral artery

Question 11

Internal iliac branches

Answer 11

Posterior
Anterior

Branches Mneumonic: I love going places in my very own underwear

Question 12

Posterior division of internal iliac

Answer 12

Iliolumbar
Lateral sacral
Superior gluteal

** rarely seen in gynae

Question 13

Anterior branches of the internal iliac

Answer 13

Umbilical artery - obliterated distally
Inferior vesical
Uterine
Middle rectal
Obturator 
Inferior gluteal
Internal pudendal

Question 14

Avascular spaces of the pelvis

Answer 14

Prevesical space (Space of retails)
Paramedical spaces
Pararectal spaces
Rectovaginal spaces (POD)

Question 15

Pararectal space location

Answer 15

Lateral to the ureter
Medial to the anterior branch of internal iliac
Posterior to uterine artery
Continues downward to the pelvic floor
Only structures crossing this. Space are the uterine artery and vein

Useful space for:

Uretrolysis
ID ureter and lilac. Vessels

Question 16

Paravesical space

Answer 16

Lies. Medial. To the obliterated hypogastric artery, caudal o the pubic bone,, anterior to uterine

Lateral border: obturator internus and obturator nerve

Can enter retropubic space through this space

Question 17

From which vessels does the ureter derive its arterial blood supply?

Answer 17

Renal
Gonadal
Internal iliac
Uterine
Vesical

I GRUV

Question 18

Layers abdo wall

Answer 18

Skin
Sub it fat
Scarpas
Rectus sheath
Preperitoneal fat
Peritoneum