| August 2006 · Vol. 18, No. 8 SURGICAL TECHNIQUES
The Retroperitoneal Space: Keeping vital structures out of harm’s way
Knowledge of the retroperitoneal space is critical, to avoid unnecessary blood loss and injury of the ureter, bladder, bowel, and nerves
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Fast Track
The ureter and anterior branch of the internal iliac artery are nearly parallel as they course through the pelvis
Definitive surgical treatment of endometriosis includes removal of the diseased peritoneum
Common sites of ureteral injury:
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at the pelvic rim near the ovarian vessels
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at the level of the uterine artery
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lateral to the vaginal cuff
The hypogastric artery is rarely ligated today because of increasing reliance on interventional
radiology for postpartum and postop bleeding
Presacral neurectomy is no longer advised
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Kenneth
D.
Hatch,
MDProfessor, Department of Obstetrics and Gynecology, Arizona Health Sciences Center,
Tucson, Ariz
The accomplished gynecologic surgeon must know the anatomy of the retroperitoneal space in order to avoid damage to normal structures, as well as remove pathology. Many disease processes involve the pelvic peritoneum, uterosacral ligaments, rectosigmoid or ovarian pedicles, and require the surgeon to enter the retroperitoneal space to identify the ureters and blood vessels and keep them out of harm’s way. The challenges are complex:
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