Avascular Spaces

Question 1

Pararectal space

Answer 1

Btw ureter and internal iliac

• medial: Uterosacral ligament, rectum
• lateral: internal iliac
• anterior: cardinal ligament
• posterior: sacrum

Question 2

Paravesical

Answer 2

Between obliterated umbilical and external iliac

• medial: bladder
• lateral: obturator/sidewall
• anterior: public symphysis
• posterior: cardinal
• floor: levator ani

Question 3

What are the avascular spaces of the pelvis?

Answer 3

1-2. Paravesical
3-4. Pararectal
5. Space of retzius
6. Presacral
7. Vesicovaginal
8. Rectovaginal

Question 4

Presacral space

Answer 4

Anterior: posterior rectal fascia
Lateral: pararectal space
Posterior: Waldeyers fascia

Question 5

Rectovaginal space

Answer 5

Anterior: vagina
Lateral: Uterosacral ligament
Posterior: rectum

Question 6

Vesicovaginal space

Answer 6

Anterior: posterior bladder
Lateral: bladder pillars
Proximal: cervix/vagina

Question 7

Borders of systematic pelvic lymphadenectomy

Answer 7

Superior: Mid-common iliac artery
Inferior: Deep circumflex iliac vein
Lateral: Mid-psoas muscle
Medial: Ureter and anterior division of internal iliac vessels
Dorsal: Obturator nerve and obturator fossa

Question 8

Borders of RIGHT para-aortic lymphadenectomy

Answer 8

Superior: Right ovarian vein entry into vena cava
Inferior: Mid-common iliac artery
Medial: IVC
Lateral: Right ureter

Question 9

Borders of LEFT para-aortic lymphadenectomy

Answer 9

Superior: Entry of left ovarian vein into left renal vein
Inferior: Mid-common iliac artery
Medial: Aorta
Lateral: Left ureter

Question 10

Space of Okabayshi

Answer 10

Medial to ureter in pararectal space

-contains hypogastric nerves

Question 11

Space of Latzko

Answer 11

Lateral to ureter in pararectal space