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Home , Abdominal wall, Cardinal ligament, Greater omentum, Inguinal canal, Lacunar ligament, Mesosalpinx

Anatomy Objectives

I. Anterior – Clinical Correlates: , Positioning/ Injury, Incisions A. Understand the layers of the anterior abdominal wall B. Identify the umbilical folds/ and their relative structures C. Identify major blood vessels, their origin and course D. Identify of anterior abdominal wall and their course E. Safe zones for trochar insertion in laparascopic surgery F. Review pfannensteil incision, vessels and nerves of concern G. Review midline incision – anterior/posterior H. Review mode of common nerve injury I. Review laparoscopic instruments

Tag the following structures: 1. External oblique muscle 2. Internal oblique muscle 3. 4. Transversus abdominis muscle 5. Transversalis 6. 7. Thoracoabdominal nerves 8. 9. 10. Inferior epigastric 11. Superficial epigastric artery 12. Superficial circumflex artery 13. Median umbilical fold – 14. Medial umbilical folds – obliterated umbilical 15. Lateral umbilical folds – inferior epigastric artery & veins 16. Superficial ring 17. Inguinal 18. Round ligament (as it comes through the superficial inguinal ring) 19. 20. and bundle (name them) 21. Arcuate line 22. Femoral sheath 23. Deep inguinal ring

II. Abdominal/ Clinical Correlates: C/S, Oncology cases A. Identify major pelvic viscera and their blood supply B. Pelvic Spaces and procedures related to them C. Identify landmarks and points of entry for lymph node dissections D. Enter and identify major structures in the presacral space: review placement of sutures for ASC, and ligation of plexus for neurectomy. E. Review the major branches off the aorta F. Trace the path of the – review risk zones G. Identify pelvic support; , Uterosacral ligaments H. Dissect and identify the branches of the internal iliac – both divisions; review placement of sutures for hypogastric artery ligation I. Review portions of tube involved in ectopic pregnancy, tubal ligations J. Review the steps of K. Review the steps of

Tag the following structures: 1. 2. – interstitial, isthmus, ampulla, infundibulum 3. Fimbria 4. 5. Mesoovarium 6. 7. Broad ligament 8. 9. Lesser omentum 10. Appendix 11. Vesicovaginal space 12. Prevesical space 13. Rectovaginal space 14. Retrorectal space 15. Pararectal space 16. Paravaginal space 17. Presacral space 18. Cardinal ligament 19. 20. Renal a/v 21. Ovarian a/v 22. Inferior mesenteric a. 23. Left colic a. 24. Sigmoid a. 25. Middle sacral a. 26. Superior hypogastric plexus 27. Lumbar a. 28. Common iliac a./v 29. External iliac a/v 30. Internal iliac a/v 31. Superior gluteal a 32. Lateral sacral a 33. Iliolumbar a. 34. Umbilical a. 35. Obturator a. 36. Vaginal a. 37. Uterine a. 38. Middle hemorrhoidal a. 39. Internal pudendal a. 40. Inferior gluteal a. 41. Ureter (3 points in its course) 42. Inferior hemorrhoidal a. 43. Inf/superior vesical a. 44. Bladder trigone 45. Nodal tissue (paraaortic – ext/int iliac – obturator) 46. Wertheim tunnel

III. Clinical Correlates: Urogyn procedures A. Identify the muscles; coccygeus and piriformis, obturator B. Identify the major bony landmarks – review them on the C. Follow the path of nerves out of the pelvis D. Identify the arcus tendineus & coopers ligament. Review steps in burch procedure, paravaginal repair, prolift, etc in these areas. E. Review relationship from floor and in steps for block. F. Review TOT/ TVT G. Review Burch and ASC H. Review TVH I. Review sacrospinous ligament fixation, uterosacral suspension

Tag the following structures: 1. Psoas major m. 2. Iliacus m. 3. Piriformis m. 4. Coccygeus m. 5. Levator ani m (components) 6. Obturator internus m. 7. Obturator foramen 8. 9. 10. Sacral promontory 11. Lesser Sciatic Foramen 12. Greater Sciatic Foramen 13. Pudendal n. 14. Lateral femoral cutaneous n. 15. Iliohypogastric n. 16. Ilioinguinal n. 17. Genitofemoral n. 18. Femoral n. 19. Obturator n. 20. Sciatic n. 21. Cooper’s ligament 22. Cardinal ligament 23. Arcus tendineus 24.

IV. Perineum Clinical correlates: OB, perineal repairs, pelvimetry A. Review again the bony landmarks, also review them on the pelvis. B. Identify Colles fascia and the perineal membrane. Review the relationship of these structures to the anterior abdominal wall. C. Identify sacrotuberous ligament, sacrospinous ligament and the vessels & nerves that course around them. D. Review & dissect the landmarks and structures within the genital triangle E. Review & dissect the landmarks and structures within the . Review structures injured during medial and mediolateral episiotomy repairs. F. Dissect out the pundendal nerve and branches. Review from this perspective the pundendal nerve block – look transbadominally as well. G. Identify the ischiorectal fossa and is relationship w/ the vessels/nerves of the pelvic cavity. H. Review TOT and TVT entry points

Tag the following structures: 1. Ischial tuberosity 2. 3. Ischial spine 4. Sacrospinous ligament 5. Colles’fascia 6. Perineal membrane (inf. Fascia of ) 7. Superior fascia of urogenital diaphragm 8. Ischiorectal fossa 9. Sacrotuberous ligament 10. 11. Bulbocavernosus muscle 12. Superficial transverse perineal m. 13. Deep transverse perineal m. 14. Sphincter urethrae 15. External sphincter ani () 16. Gluteus maximus 17. Internal pudendal vessels 18. Internal pudendal n. 19. Inferior hemorrhoidal a. 20. Inferior hemorrhoidal n. 21. Perineal a. & n. 22. Posterior labial a. & n. 23. Dorsal n & a. of 24. Bartholin’s gland 25. Pubourethral ligament 26. Inferior gluteal a.