Handa 9781496386441 Full Sample Chap 1

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CHAPTER 1  Surgical Anatomy of the Female Pelvis

I

Ovarian a.

IVC

Aorta

Ovarian v. Ureter

Common iliac a.

Ovarian fossa

Promontory

Rectum

Uterus

external iliac arteries. The internal iliac vessels lie within the pelvic retroperitoneal region and are discussed later. The external iliac vessels have a consistent course on the medial surface of psoas major muscles. Shortly before these vessels pass under the inguinal ligament to become the femoral vessels, they give up the inferior epigastric and deep circumflex iliac vessels. The deep circumflex iliac vein usually passes over the external iliac artery and is often used as a landmark for the cau- dal limit of external iliac lymphadenectomy. The aorta and vena cava are surrounded by lymph nodes on all sides. Surgeons usually refer to this lum- bar chain of nodes as the para-aortic nodes, reflecting their position. They receive the drainage from the com- mon iliac nodes and are the final drainage of the pelvic viscera. In addition, they collect the lymphatic drainage from the ovaries that follows the ovarian vessels and does not pass through the iliac nodes. The nodes of the FIGURE 1.33  Structures of the retroperitoneum. Note the anomalous origin of the left ovarian artery from the left renal artery rather than from the aorta. (The origi- nal illustration is in the Max Brödel Archives in the Department of Art as Applied to Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. Used with permission.)

Tube

Bladder

Ovary

Round ligament

lumbar chain extend from the right side of the vena cava to the left of the aorta and can be found both ante- rior and posterior to the vessels. Above the pelvic brim, the ureters are attached loosely to the posterior abdominal wall, and when the overlying colon is mobilized, they remain on the body wall. They are crossed anteriorly by the ovarian vessels, which contribute a branch to supply the ure- ter. Additional blood supply to the abdominal portion comes from the renal vessels and the common iliac artery. Presacral Space The presacral space begins below the bifurcation of the aorta and is bounded laterally by the common and internal iliac arteries ( FIGS. 1.34 and 1.35 ). It extends inferiorly to the superior fascia of the levator muscles

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