Blood vessels

Question 1

Where do the lymphatics of the vulva drain?

Answer 1

Superficial inguinal nodes

Question 2

What is the femoral triangle?

Answer 2

Subfascial space of the upper one third of the thigh.
- Bounded by the inguinal ligament, sartorius muscle, and adductor longus muscle
- Floor formed by the pectineal,
adductor longus, and iliopsoas muscles
- Femoral artery bisects the same, vein medial to artery, nerve lateral (VAN)

Question 3

What is the path of the uterine artery?

Answer 3

Arcuate (along the sides of the uterus)
Crosses over the ureter in the cardinal ligament and gives off cervical and vaginal branches
before ascending adjacent to the wall of the uterus and anastomosing with the medial end of the ovarian artery

Question 4

What supports the ovary?

Answer 4

Lateral: Pelvic wall by the infundibulopelvic ligament (contains ovarian artery and vein)
Medial: Utero-ovarian ligament, mesoovarium (broad ligament)

Question 5

What is the path of the round ligament?

Answer 5

Anterior corpus > retroperitoneal tissue (pass lateral to the deep inferior epigastric vessels) > internal inguinal ring > labia majora

Question 6

Where do the ovarian vessels come from?

Answer 6

Directly from the aorta below the renal vessels

Question 7

Where do the ovarian veins drain?

Answer 7

Right: Vena cava
Left: Renal vein

“right to ivc”

Question 8

What is the blood supply of the fallopian tube?

Answer 8

Branches of the ovarian vessels through the mesosalpinx. Watch out for a prominent fimbrial branch at the lateral end of the tube!

Question 9

What is the blood supply of the vagina?

Answer 9

Uterine vessels, pudendal vessels (distal vagina), and middle and inferior hemorrhoidal vessels (posterior wall)

Question 10

What is the fascia of Denonvilliers?

Answer 10

Between the vaginal wall and rectum (cul-de-sac of Douglas to the top of the perineal body)

Question 11

What is the anterior cul-de-sac?

Answer 11

Recess between the dome of the bladder and the anterior surface of the uterus
- Its loose peritoneum forms the vesicouterine fold (e.g., your bladder flap), but also is several cm away when you enter vaginally

Question 12

What is the posterior cul-de-sac?

Answer 12

Anterior: Vagina
Posterior: Rectosigmoid
Lateral: Uterosacral ligaments

Question 13

What is the prevescical space or the space of Retzius?

Answer 13

Lateral: Bony pelvis, attachment of bladder to cardinal ligament), attachment of pubocervical fascia to obturator internus
Cranial: Abdominal wall.
Important structures: Dorsal clitoral vessels, obturator nerve and vessels, bladder nerves

Question 14

What is the rectovaginal space?

Answer 14

Apex of the perineal body upward to the cul-de-sac Laterally around the sides of the rectum to the attachment of the rectovaginal septum

Question 15

What lies near the sacrospinous ligament?

Answer 15

Sacral plexus
Pudenal nerve
Venous plexus of internal iliac vein
Middle rectal vessels

Question 16

What side is the aorta on relative to the vena cava?

Answer 16

The left

Question 17

Where does the aorta bifurcate?

Answer 17

At the level of the fourth lumbar vertebra (just below the umbilicus)

Question 18

What drains into the para-aortic nodes?

Answer 18

Drainage from the common iliac nodes (final drainage of the pelvic viscera) and ovaries

Question 19

What is the presacral space?

Answer 19

Below the bifurcation of the aorta
Lateral: internal iliac arteries
Important structures: Middle sacral vessels, lateral sacral vessels, presacral nerve (superior hypogastric plexus - involved in orgasm)

Question 20

What are the posterior branches of the internal iliac artery?

Answer 20

Iliolumbar artery
Lateral sacral artery
Superior gluteal artery

Question 21

What are the anterior branches of the internal iliac artery?

Answer 21

Obturator artery
Internal pudendal artery
Inferior gluteal artery
Uterine artery
Superior vesical artery
Vaginal (inferior vesical) artery
Middle rectal artery

Question 22

What are the branches of the aorta before bifurcation?

Answer 22

Renal
Ovary
Inferior Mesenteric
Lumbar

Question 23

Where are the inferior and superior epigastric vessels?

Answer 23

Just above the pubic symphysis, the vessels lie approximately 5.5 cm from the midline, whereas at the level of the umbilicus, they are 4.5 cm from the
midline.

Question 24

Location of inferior mesenteric artery (IMA)

Answer 24

3-6 cm above aortic bifurcation

Question 25

Location of renal veins

Answer 25

Reflect 3rd part of duodenum to see

• Left renal vein: 4-5 cm above IMA
• Right renal vein (usually not exposed): Inferior and lateral insertion into IVC

Question 26

Lumbar veins are most at risk during which side of para-aortic lymphadenectomy?

Answer 26

Left

• Left ascending lumbar vein parallel to aorta
• Otherwise, lumbar veins behind aorta