female pelvic applied anatomy by dr shashwat jani
DESCRIPTION
FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANITRANSCRIPT
![Page 1: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/1.jpg)
Female Pelvic Applied Anatomy
Dr. SHASHWAT JANIM.S. ( GYNEC )
DIPLOMA IN ADVANCED ENDOSCOPY.
Assistant Professor Smt. N.H.L. MUNICIPAL MEDICAL COLLEGE , AHMEDABAD.
Mob : +91 99099 44160.
E-mail : [email protected]
![Page 2: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/2.jpg)
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….
![Page 3: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/3.jpg)
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.
![Page 4: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/4.jpg)
Bony Pelvis
Organ anatomy
Spaces
Vascular anatomy
Neuroanatomy
Topics Covered..
![Page 5: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/5.jpg)
Nomenclature used here reflects current slandered
nomenclature according to
the Nomina Anatomica*.
*International Anatomical Nomenclature Committee: Edinburg, Scotland.
(founded in 1989)
![Page 6: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/6.jpg)
Female Pelvis : Evolvement
•Forms a bony ring through with body weight is transmitted to lower
extremities.
•Adopts to child bearing.
![Page 7: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/7.jpg)
Pelvic Structure
Sacrum
Coccyx
Paired Hip Bones ( Os Coxae, innominate )
![Page 8: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/8.jpg)
Sacrum and CoccyxExtension of Vertebral Column:
Fused 5 sacral and 4 coccygeal vertebrae
![Page 9: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/9.jpg)
Os Coxae ( Hip Bones )
![Page 10: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/10.jpg)
Pelvic Bone Articulation
Sacro-illiac Joint :
Synchondroses
Symphysis pubis
Sacrococcygial joint
Cartilaginous symphyseal joint
![Page 11: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/11.jpg)
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
![Page 12: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/12.jpg)
Sacral Promotory Fixation
![Page 13: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/13.jpg)
Pudendal Nerve Block
![Page 14: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/14.jpg)
Pelvic Inlet
False Pelvis
True Pelvis
Linea T
erminalis
![Page 15: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/15.jpg)
Boundaries of False Pelvis Posterior : Lumber Vertebrae Anterior: Lower portion of Anterior abdominal wall Laterally: iliac Fossa
![Page 16: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/16.jpg)
Upper: Pelvic Inlet Lower : Pelvic Outlet
Boundaries of True Pelvis
SPSP ASAS
LTLT
Pubic BonePubic Bone
•Obliquely Truncated
•Bent Cylinder
•Greatest Height Posteriorly
![Page 17: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/17.jpg)
Pelvic Planes and Axis
![Page 18: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/18.jpg)
Conjugates
![Page 19: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/19.jpg)
Outlet
Symphisis pubis
Coccyx
![Page 20: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/20.jpg)
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
![Page 21: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/21.jpg)
Sacrospinous fixation
![Page 22: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/22.jpg)
Bladder Suspension Procedureon cooper’s Ligament
![Page 23: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/23.jpg)
Normal Variants
![Page 24: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/24.jpg)
Pelvic Viscera
![Page 25: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/25.jpg)
![Page 26: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/26.jpg)
![Page 27: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/27.jpg)
Peritoneal Orientation
![Page 28: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/28.jpg)
![Page 29: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/29.jpg)
![Page 30: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/30.jpg)
Hystero Laparo Scopy
![Page 31: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/31.jpg)
Pelvic Floor
![Page 32: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/32.jpg)
![Page 33: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/33.jpg)
![Page 34: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/34.jpg)
![Page 35: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/35.jpg)
Levator Ani muscle
![Page 36: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/36.jpg)
Pelv
ic F
loor
![Page 37: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/37.jpg)
Vascular anatomyThe common iliac bifurcation is at the level of
sacral promontory.
![Page 38: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/38.jpg)
![Page 39: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/39.jpg)
![Page 40: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/40.jpg)
Ext Iliac Artery
2 branches :
Inf Epigastric
Deep Circumflex iliac A.
![Page 41: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/41.jpg)
Inferior Epigastric
![Page 42: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/42.jpg)
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.
![Page 43: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/43.jpg)
Vasclar Anatomy : Internal Iliac
The internal iliac ( Hypogastric )artery divides into anterior and posterior divisions.
![Page 44: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/44.jpg)
Internal iliac (Hypogastric) artery
10 branches
![Page 45: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/45.jpg)
Internal Iliac Ligation
![Page 46: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/46.jpg)
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
![Page 47: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/47.jpg)
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.
![Page 48: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/48.jpg)
![Page 49: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/49.jpg)
Uterine Artery
![Page 50: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/50.jpg)
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.
![Page 51: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/51.jpg)
SPACES
There are four important spaces:
Retro pubic space
Para vesical space
Pouch of Douglas
Para rectal space
![Page 52: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/52.jpg)
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.
![Page 53: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/53.jpg)
Pararectal space
ureter
Internal Iliac A.
Obliterate umbilical A.
Uterine A
Exterrnal Iliac vs.
![Page 54: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/54.jpg)
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.
![Page 55: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/55.jpg)
Pararectal & Paravesical spaces
![Page 56: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/56.jpg)
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.
![Page 57: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/57.jpg)
Pouch of DouglasThe pouch of Douglas is bounded by cardinal and
uterosacral ligaments on either side, the uterus anteriorly and rectum posteriorly.
![Page 58: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/58.jpg)
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.
![Page 59: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/59.jpg)
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.
![Page 60: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/60.jpg)
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. .
![Page 61: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/61.jpg)
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.
![Page 62: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/62.jpg)
Innervations of Reproductive Organs
![Page 63: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/63.jpg)
Innervation ofPelvic Viscera
![Page 64: FEMALE PELVIC APPLIED ANATOMY BY DR SHASHWAT JANI](https://reader035.vdocument.in/reader035/viewer/2022081716/5470669baf795910188b477f/html5/thumbnails/64.jpg)
THANK
YOU. . .! ! !