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Anatomy Objectives

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Anatomy Objectives I. Anterior Abdominal Wall – Clinical Correlates: Laparoscopy, Positioning/Nerve Injury, Incisions A. Understand the layers of the anterior abdominal wall B. Identify the umbilical folds/ligaments and their relative structures C. Identify major blood vessels, their origin and course D. Identify nerves 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 rectus sheath H. Review mode of common nerve injury I. Review laparoscopic instruments Tag the following structures: 1. External oblique muscle 2. Internal oblique muscle 3. Rectus abdominis muscle 4. Transversus abdominis muscle 5. Transversalis fascia 6. Pyramidalis muscle 7. Thoracoabdominal nerves 8. Iliohypogastric nerve 9. Ilioinguinal nerve 10. Inferior epigastric artery 11. Superficial epigastric artery 12. Superficial circumflex artery 13. Median umbilical fold – urachus 14. Medial umbilical folds – obliterated umbilical arteries 15. Lateral umbilical folds – inferior epigastric artery & veins 16. Superficial inguinal ring 17. Inguinal ligament 18. Round ligament (as it comes through the superficial inguinal ring) 19. Lacunar ligament 20. Inguinal canal and bundle (name them) 21. Arcuate line 22. Femoral sheath 23. Deep inguinal ring II. Abdominal/Pelvic Cavity 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 ureter – review risk zones G. Identify pelvic support; Cardinal ligament, 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 hysterectomy K. Review the steps of appendectomy Tag the following structures: 1. Uterus 2. Fallopian tube – interstitial, isthmus, ampulla, infundibulum 3. Fimbria 4. Mesosalpinx 5. Mesoovarium 6. Ovary 7. Broad ligament 8. Greater omentum 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. Uterosacral ligament 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. Pelvic Floor Clinical Correlates: Urogyn procedures A. Identify the levator ani muscles; coccygeus and piriformis, obturator B. Identify the major bony landmarks – review them on the pelvis 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 perineum in steps for pudendal nerve 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. Ischial spine 9. Ischial tuberosity 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. Pectineal line 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 anal triangle. 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. Ischiopubic ramus 3. Ischial spine 4. Sacrospinous ligament 5. Colles’fascia 6. Perineal membrane (inf. Fascia of urogenital diaphragm) 7. Superior fascia of urogenital diaphragm 8. Ischiorectal fossa 9. Sacrotuberous ligament 10. Ischiocavernosus muscle 11. Bulbocavernosus muscle 12. Superficial transverse perineal m. 13. Deep transverse perineal m. 14. Sphincter urethrae 15. External sphincter ani (external anal sphincter) 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 clitoris 24. Bartholin’s gland 25. Pubourethral ligament 26. Inferior gluteal a. .
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