FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI

FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI

1. Female Pelvic
Applied Anatomy
Dr. SHASHWAT JANI
M.S. ( GYNEC )
DIPLOMA IN ADVANCED ENDOSCOPY.
Assistant Professor Smt. N.H.L. MUNICIPAL
MEDICAL COLLEGE , AHMEDABAD.
Mob : [phone].
E-mail : [email protected]

2. Basic Facts of Anatomy
do not Change
But our understanding does…
Exploration of specific anatomic relationships and the
development of new clinical and surgical correlation
continue to evolve….

3. Comprehensive understanding of
Anatomy is essential for ..
Avoiding visceral injuries : About 75 % iatrogenic
injuries to ureter result from Gynecological
surgeries…. 
Understanding of interrelation ship of Bony pelvis,
ligaments , muscles, fasciae , nerves , blood vessels
and pelvic viscera for safe and effective management
of Pelvic floor Disorders.
Understanding and managing the normal and
abnormal Obstetric conditions.

4. Bony Pelvis
Organ anatomy
Spaces
Vascular anatomy
Neuroanatomy
Topics Covered..

5. Nomenclature used here reflects current slandered
nomenclature according to
the Nomina Anatomica*.
*International Anatomical Nomenclature Committee: Edinburg, Scotland.
(founded in 1989)

6. Female Pelvis : Evolvement
•Forms a bony ring through with body weight is transmitted to lower
extremities.
•Adopts to child bearing.

7. Pelvic Structure
Sacrum
Coccyx
Paired Hip Bones ( Os Coxae, innominate )

8. Sacrum and Coccyx
Extension of Vertebral Column:
Fused 5 sacral and 4 coccygeal vertebrae

9. Os Coxae ( Hip Bones )

10. Pelvic Bone Articulation
Sacro-illiac Joint :
Synchondroses
Symphysis pubis
Sacrococcygial joint
Cartilaginous
symphyseal joint

11. Important Landmarks
Symphysis Pubis and Pubic Tubercle: Pelvimetry,
Symphysotomy etc…
Sacral Promontory: Landmark in Laparoscopy, Bifurcation
of Major Vessels, Prolapse repair
Sacral hiatus
Iliac Crest
Anterior Superior iliac Spine: Surgical Landmark
Ischial Spine: Pudendal Block , Clinical Pelvimetry
Ischial Tuberosity

12. Sacral Promotory Fixation

13. Pudendal Nerve Block

14. Pelvic Inlet
False Pelvis
True Pelvis
L
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T
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15. Boundaries of False Pelvis
Posterior : Lumber Vertebrae
Anterior: Lower portion of Anterior abdominal wall
Laterally: iliac Fossa

16. Upper: Pelvic Inlet
Lower : Pelvic Outlet
Boundaries of True Pelvis
SPSP
ASAS
LTLT
Pubic BonePubic Bone
•Obliquely Truncated
•Bent Cylinder
•Greatest Height Posteriorly

17. Pelvic Planes and Axis

18. Conjugates

19. Outlet
Symphisis pubis
Coccyx

20. Four Ligaments
Inguinal Ligament
•Important for repair of Inguial Hernia
Cooper’s Ligament
•Frequently used in Bladder suspension
procedures.
Sacrospinous Ligament
•For Vaginal Suspension
Sacrotubourous Ligament

21. Sacrospinous fixation

22. Bladder Suspension Procedure
on cooper’s Ligament

23. Normal Variants

24. Pelvic Viscera

27. Peritoneal Orientation

30. Hystero Laparo Scopy

31. Pelvic Floor

35. Levator Ani muscle

36. P
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F
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37. Vascular anatomy
The common iliac bifurcation is at the level of sacral
promontory.

40. Ext Iliac Artery
2 branches :
Inf Epigastric
Deep Circumflex iliac A.

41. Inferior Epigastric

42. The external iliac artery lies lateral to external iliac
vein.
The inferior epigastric artery is the only branch of
external iliac artery.
The inferior epigastric vein drains into the external
iliac vein.

43. Vasclar Anatomy :
Internal Iliac
The internal iliac ( Hypogastric )artery divides into
anterior and posterior divisions.

44. Internal iliac
(Hypogastric) artery
10 branches

45. Internal Iliac Ligation

46. Uterine Artery
The uterine artery is the first branch of anterior division
of internal iliac artery. It originates about 6”(six
inches) distal to the bifurcation of common iliac artery

47. Internal Iliac & Uterine A.
Thus, there is sufficient length of internal artery
available for ligation. After giving out uterine artery,
the internal iliac artery continues further as obliterated
hypogastric artery.
The uterine artery traverses through the Para rectal
space and crosses above the ureter from lateral to
medial side to enter the uterus.

49. Uterine Artery

50. Uterine Artery & Vein
The Uterine vein, contrary to popular belief, comes
from below the ureter to join the internal iliac vein.
Thus, the ureter lies in the fork with the uterine artery
above and the uterine vein below.

51. SPACES
There are four important spaces:
Retro pubic space
Para vesical space
Pouch of Douglas
Para rectal space

52. Para rectal space
The Para rectal space lies…
 lateral to the ureter
medial to the internal iliac vessels.
It continues downwards upto the levator ani muscle.
The only structures crossing this space are
Uterine artery
Uterine vein.

53. Pararectal space
ureter
Internal Iliac A.
Obliterate umbilical A.
Uterine A
Exterrnal Iliac vs.

54. Paravesical space
The paravesical space lies medial to the obliterated
hypogastric artery and is bounded caudally by the
pubic bone.
The retro pubic space can be entered through this
space.

55. Pararectal & Paravesical
spaces

56. Retro pubic space
The retro pubic space is bounded by the obliterated
hypogastric artery on either side, the pubic
symphysis anteriorly and the urinary bladder
posteriorly.

57. Pouch of Douglas
The pouch of Douglas is bounded by cardinal and
uterosacral ligaments on either side, the uterus
anteriorly and rectum posteriorly.

58. The veins run in the uterosacral and cardinal
ligaments. Likewise, the lymphatics also run in these
ligaments along the veins. Hence, the ligaments are
cut as laterally as possible in cancer surgery.
The small veins run in the paracolpos.

59. The circumflex iliac vein, which drains into external
iliac vein from medially, is very liable to get damaged
during nodal dissection.
The obturator artery and vein run parallel to the
obturator nerve.
The obturator nerve originates at the bifurcation of
common iliac vessels and then runs caudally between
the external and internal iliac vessels.

60. Lymphatic Drainage
The lymphaticsThe lymphatics from the uterus travel along the infundibulopelvic from the uterus travel along the infundibulopelvic
ligament and drain into the ligament and drain into the para-aortic group of nodespara-aortic group of nodes. .

61. Lymphatics
Lymphatics from cervix and upper vagina go along
the paracolpos and cardinal ligament and drain into
the ileo-obturator nodes. The obturator node is the
first echelon of spread from the cervical cancers.
Lymphatics from the ovaries go along the infundibulo-
pelvic ligaments and drain into the Para-aortic group
of nodes.

62. Innervations of Reproductive Organs

63. Innervation of
Pelvic Viscera

64. THANK
YOU. . .!
! !