A simplified fascial model of pelvic anatomical surgery: going beyond parametrium-centered surgical anatomy
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ORIGINAL ARTICLE
A simplified fascial model of pelvic anatomical surgery: going beyond parametrium‑centered surgical anatomy Stefano Cosma1 · Domenico Ferraioli2 · Marco Mitidieri3 · Marcello Ceccaroni4 · Paolo Zola5 · Leonardo Micheletti1 · Chiara Benedetto1 Received: 13 March 2020 / Accepted: 5 June 2020 © The Author(s) 2020
Abstract The classical surgical anatomy of the female pelvis is limited by its gynecological oncological focus on the parametrium and burdened by its modeling based on personal techniques of different surgeons. However, surgical treatment of pelvic diseases, spreading beyond the anatomical area of origin, requires extra-regional procedures and a thorough pelvic anatomical knowledge. This study evaluated the feasibility of a comprehensive and simplified model of pelvic retroperitoneal compartmentalization, based on anatomical rather than surgical anatomical structures. Such a model aims at providing an easier, holistic approach useful for clinical, surgical and educational purposes. Six fresh-frozen female pelves were macroscopically and systematically dissected. Three superficial structures, i.e., the obliterated umbilical artery, the ureter and the sacrouterine ligament, were identified as the landmarks of 3 deeper fascial-ligamentous structures, i.e., the umbilicovesical fascia, the urogenital-hypogastric fascia and the sacropubic ligament. The retroperitoneal areolar tissue was then gently teased away, exposing the compartments delimited by these deep fascial structures. Four compartments were identified as a result of the intrapelvic development of the umbilicovesical fascia along the obliterated umbilical artery, the urogenital-hypogastric fascia along the mesoureter and the sacropubic ligaments. The retroperitoneal compartments were named: parietal, laterally to the umbilicovesical fascia; vascular, between the two fasciae; neural, medially to the urogenital-hypogastric fascia and visceral between the sacropubic ligaments. The study provides the scientific rational for a model of pelvic retroperitoneal anatomy based on identifiable anatomical structures and suitable for surgical planning and training. Keywords Compartments · Parametrium · Pararectal space · Paravesical space · Pelvic retroperitoneum Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12565-020-00553-z) contains supplementary material, which is available to authorized users. * Stefano Cosma [email protected] 1
Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Torino, Via Ventimiglia 3, 10126 Turin, Italy
2
Department of Oncology Surgery, Léon Bérard Comprehensive Cancer Center, Lyon, France
3
Gynecology and Obstetrics 4, Department of Obstetrics and Gynaecology, City of Health and Science, Turin, Italy
4
Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS Sacro Cuore Hospital, Verona, Italy
5
Gynecolog
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