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Anatomy
Published in Alison Edwards, Labour Midwifery Skills, 2020
Six layers:Skin.Fat.Superficial muscles – transverse perinea, bulbocavernosa, ischiocavernosus. The urethral and anal sphincters are also found here.Deep muscle layer – iliococcygeus, ischiococcygeus and the pubococcygeus.Pelvic fascia which forms the pelvic ligaments.Peritoneum.
Anatomy
Published in J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan, An Atlas of Gynecologic Oncology, 2018
Ernest F. Talarico, Jalid Sehouli, Giuseppe Del Priore, Werner Lichtenegger
Parietal pelvic fascia lines the muscles that form the pelvic walls and floor, and is continuous with transversalis and iliopsoas fascias. Visceral pelvic fascia encloses pelvic organs and forms their adventitial layers. Both parietal and visceral fascias are continuous where viscera penetrate the pelvic floor. Here, parietal fascia thickens, forming the bilateral tendinous arch (arcus) that courses from pubis to sacrum (Figures 4.2 and 4.3), adjacent to the viscera. In females, the arcus is divided into the anterior pubovesicular ligament and the posterior sacrogenital ligaments. This lateral attachment of visceral fascia of the vagina with the arcus is called the paracolpium. The paracolpium supports the vagina and assists in the weight bearing of the urinary fundus. Because of its anatomical course and thickness, the arcus can be used to anchor sutures during reconstructive procedures.
The development and anatomy of the female sexual organs and pelvis
Published in Helen Bickerstaff, Louise C Kenny, Gynaecology, 2017
Connective tissue fills the irregular spaces between the various pelvic organs. Much of it is loose cellular tissue, but in some places it is condensed to form strong ligaments that contain some smooth muscle fibres and which form the fascial sheaths that enclose the various viscera. The pelvic arteries, veins, lymphatics, nerves and ureters run through it. The cellular tissue is continuous above with the extraperitoneal tissue of the abdominal wall, but below it is cut off from the ischiorectal fossa by the pelvic fascia and the levator ani muscles. The pelvic fascia may be regarded as a specialized part of this connective tissue and has parietal and visceral components.
Hydrodissection performed safely with an injection catheter during robot-assisted radical prostatectomy
Published in Arab Journal of Urology, 2023
Jotaro Mikami, Jun Ito, Yuki Kohada, Nao Iwamoto, Hiroki Kusumoto, Takashi Kukimoto, Masaaki Oikawa, Yasuhiro Kaiho
HD during robot-assisted RP was performed with the approval of the Clinical Research Ethics Board of Tohoku Medical and Pharmaceutical Hospital (approval number: 2021-4-022). An injection catheter with a 22 G needle and a 4 mm long needle tip (Olympus, Tokyo, Japan), commonly used for endoscopic upper gastrointestinal hemostasis, was inserted through a 5-mm assistant port. The operator controlled the catheter using robotic arms and placed the needle tip in the lateral pelvic fascia of the NS side of the prostate. An assistant operator injected approximately 10 mL of saline (Figure 1, Supplemental video 1). An epinephrine solution has been commonly used for HD to prevent bleeding during RP; however, in robot-assisted RP, pure saline can be used for HD without problems. After HD, lateral pelvic fasciae incisions that were hydrodissected by injected saline were placed at the 2 (10) o’clock position of the prostate in the axial section to preserve nerve fibers in the anterolateral and posterolateral aspects of the prostate. Injected saline usually spreads within the lateral pelvic fascia (interfascial dissection); however, it seldom spreads between the lateral pelvic fascia and the prostatic capsule (intra-fascial dissection). If intra-fascial NS is required, the remaining lateral pelvic fasciae, after incising the hydrodissected lateral pelvic fasciae, are incised further until the surface of the prostate is exposed.
The transvaginal mesh: an overview of indications and contraindications for its use
Published in Expert Review of Medical Devices, 2023
Alessandro Ferdinando Ruffolo, Marine Lallemant, Sophie Delplanque, Michel Cosson
POP is the result of laxity in the four main suspensory pelvic ligaments (pubourethral, cardinal, arcus tendinous of pelvic fascia and uterosacral) and of perineal body defects [44]. The bladder (cystocele), the uterus (hysterocele), the pouch of Douglas (elytrocele) and the rectum (rectocele) may be involved in the vaginal prolapse, differently from the rectal prolapse that is an exteriorization of the rectum through the anal orifice. The restoration of ligaments’ length and tension leads to anatomical and functional improvement [44].
Topography of the pelvic autonomic nerves – an anatomical study to facilitate nerve-preserving total mesorectal excision
Published in Acta Chirurgica Belgica, 2022
Jan Gaessler, Friedrich Anderhuber, Sabine Kuchling, Ulrike Pilsl
Colorectal cancer is one of the most common malignancies worldwide. In both sexes combined, it ranks third in terms of incidence (10.2%), and second in terms of mortality (9.2%) [1]. After the proximal colon, the rectum represents the second most frequent tumour subsite (28%) in colorectal cancer [2]. The European Society for Medical Oncology defines rectal cancer as a lesion whose distal extension is located ≤15 cm from the anal margin (measured using rigid sigmoidoscopy) [3]. Total mesorectal excision (TME) represents the contemporary gold standard in radical surgical treatment of advanced rectal cancer [3]. TME can be defined as 'sharp, meticulous extirpation of the cancer en bloc with its surrounding perirectal lymphatic tissue contained within a thin fascial layer' [4]. The principle of TME is based on the understanding that 'removal of the whole visceral mesentery of the rectum' (i.e. the mesorectum) confines the entirety of tumour cells, thereby reducing local recurrence. The respective surgical plane has been established as the 'holy plane' of rectal cancer surgery. Posteriorly, it is located between mesorectum and presacral fascia, and extends laterally between mesorectum and parietal pelvic fascia (PPF) [5]. Anterior to the mesorectum, which contains small vessels, lymph nodes, and adipose tissue, lies the rectogenital septum (RGS). In women, it separates the rectum from the vagina (rectovaginal fascia). In men, it separates the rectum from the prostate (rectoprostatic or Denonvilliers' fascia, DVF). The adoption of TME has been pivotal in substantially reducing the local tumour recurrence rate [4]. The oncological superiority of TME can be ascribed to the practice of meticulously mobilising the mesorectum using sharp dissection which minimises the risk of breaching the enveloping mesorectal fascia (MRF), also called the visceral pelvic fascia. TME has also had a favourable impact on the preservation rate of urogenital function, because it facilitates the identification and sparing of the pelvic autonomic nerves [4]. Despite the ongoing progress in that particular field of surgery (i.e. transanal approach, robot-assisted surgery), urogenital dysfunction following rectal cancer surgery remains a common occurrence [6].