A Detailed Study of the Course, Branching Pattern and Dimensions of the Uterine and Vaginal Arteries and Their Branches
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A New Anatomic and Staging-Oriented Classification Of
cancers Perspective A New Anatomic and Staging-Oriented Classification of Radical Hysterectomy Mustafa Zelal Muallem Department of Gynecology with Center for Oncological Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Virchow Campus Clinic, Charité Medical University, 13353 Berlin, Germany; [email protected]; Tel.: +49-30-450-664373; Fax: +49-30-450-564900 Simple Summary: The main deficits of the available classifications of radical hysterectomy are the facts that they are based only on the lateral extension of resection, do not depend on the precise anatomy of parametrium and paracolpium and do not correlate with the tumour stage, size or infiltration in the vagina. This new suggested classification depends on the 3-dimentional concept of parametrium and paracolpium and the comprehensive description of the anatomy of parametrium, paracolpium and the pelvic autonomic nerve system. Each type in this classification tailored to the tumour stage according to FIGO- classification from 2018, taking into account the tumour size, localization and infiltration in the vaginal vault, which may make it the most suitable tool for planning and tailoring the surgery of radical hysterectomy. Abstract: The current understanding of radical hysterectomy more is centered on the uterus and little is being discussed about the resection of the vaginal cuff and the paracolpium as an essential part of this procedure. This is because that the current classifications of radical hysterectomy are based only on the lateral extent of resection. This way is easier to be understood but does not reflect Citation: Muallem, M.Z. -
Vessels and Circulation
CARDIOVASCULAR SYSTEM OUTLINE 23.1 Anatomy of Blood Vessels 684 23.1a Blood Vessel Tunics 684 23.1b Arteries 685 23.1c Capillaries 688 23 23.1d Veins 689 23.2 Blood Pressure 691 23.3 Systemic Circulation 692 Vessels and 23.3a General Arterial Flow Out of the Heart 693 23.3b General Venous Return to the Heart 693 23.3c Blood Flow Through the Head and Neck 693 23.3d Blood Flow Through the Thoracic and Abdominal Walls 697 23.3e Blood Flow Through the Thoracic Organs 700 Circulation 23.3f Blood Flow Through the Gastrointestinal Tract 701 23.3g Blood Flow Through the Posterior Abdominal Organs, Pelvis, and Perineum 705 23.3h Blood Flow Through the Upper Limb 705 23.3i Blood Flow Through the Lower Limb 709 23.4 Pulmonary Circulation 712 23.5 Review of Heart, Systemic, and Pulmonary Circulation 714 23.6 Aging and the Cardiovascular System 715 23.7 Blood Vessel Development 716 23.7a Artery Development 716 23.7b Vein Development 717 23.7c Comparison of Fetal and Postnatal Circulation 718 MODULE 9: CARDIOVASCULAR SYSTEM mck78097_ch23_683-723.indd 683 2/14/11 4:31 PM 684 Chapter Twenty-Three Vessels and Circulation lood vessels are analogous to highways—they are an efficient larger as they merge and come closer to the heart. The site where B mode of transport for oxygen, carbon dioxide, nutrients, hor- two or more arteries (or two or more veins) converge to supply the mones, and waste products to and from body tissues. The heart is same body region is called an anastomosis (ă-nas ′tō -mō′ sis; pl., the mechanical pump that propels the blood through the vessels. -
Intra and Retroperitoneal Anatomy – Landmarks and Pearls of Dissection (Didactic)
Intra and Retroperitoneal Anatomy – Landmarks and Pearls of Dissection (Didactic) PROGRAM CHAIR Vadim Morozov, MD PROGRAM CO-CHAIR Maurizio Rosati, MD E. Cristian Campian, MD Cristina C. Enzmann, MD Nucelio Lemos, MD S. Sony Singh, MD Pamela T. Soliman, MD Sponsored by AAGL Advancing Minimally Invasive Gynecology Worldwide Professional Education Information Target Audience This educational activity is developed to meet the needs of residents, fellows and new minimally invasive specialists in the field of gynecology. Accreditation AAGL is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AAGL designates this live activity for a maximum of 3.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS As a provider accredited by the Accreditation Council for Continuing Medical Education, AAGL must ensure balance, independence, and objectivity in all CME activities to promote improvements in health care and not proprietary interests of a commercial interest. The provider controls all decisions related to identification of CME needs, determination of educational objectives, selection and presentation of content, selection of all persons and organizations that will be in a position to control the content, selection of educational methods, and evaluation of the activity. Course chairs, planning committee members, presenters, authors, moderators, panel members, and others in a position to control the content of this activity are required to disclose relevant financial relationships with commercial interests related to the subject matter of this educational activity. Learners are able to assess the potential for commercial bias in information when complete disclosure, resolution of conflicts of interest, and acknowledgment of commercial support are provided prior to the activity. -
Anatomy of the Visceral Branches of the Iliac Arteries in Newborns
MOJ Anatomy & Physiology Research Article Open Access Anatomy of the visceral branches of the iliac arteries in newborns Abstract Volume 6 Issue 2 - 2019 The arising of the branches of the internal iliac artery is very variable and exceeds in this 1 2 feature the arterial system of any other area of the human body. In the literature, there is Valchkevich Dzmitry, Valchkevich Aksana enough information about the anatomy of the branches of the iliac arteries in adults, but 1Department of normal anatomy, Grodno State Medical only a few research studies on children’s material. The material of our investigation was University, Belarus 23 cadavers of newborns without pathology of vascular system. Significant variability of 2Department of clinical laboratory diagnostic, Grodno State iliac arteries of newborns was established; the presence of asymmetry in their structure was Medical University, Belarus shown. The dependence of the anatomy of the iliac arteries of newborns on the sex was revealed. Compared with adults, the iliac arteries of newborns and children have different Correspondence: Valchkevich Dzmitry, Department structure, which should be taken into account during surgical operations. of anatomy, Grodno State Medical University, Belarus, Tel +375297814545, Email Keywords: variant anatomy, arteries of the pelvis, sex differences, correlation, newborn Received: March 31, 2019 | Published: April 26, 2019 Introduction morgue. Two halves of each cadaver’s pelvis was involved in research, so 46 specimens were used in total: 18 halves were taken from boy’s Diseases of the cardiovascular system are one of the leading cadavers (9 left and 9 right) and 27 ones from the girls cadavers (14 problems of modern medicine. -
MORPHOLOGICAL STUDY of OBTURATOR ARTERY Pavan P Havaldar *1, Sameen Taz 2, Angadi A.V 3, Shaik Hussain Saheb 4
International Journal of Anatomy and Research, Int J Anat Res 2014, Vol 2(2):354-57. ISSN 2321- 4287 Original Article MORPHOLOGICAL STUDY OF OBTURATOR ARTERY Pavan P Havaldar *1, Sameen Taz 2, Angadi A.V 3, Shaik Hussain Saheb 4. *1,4 Assistant Professors Department of Anatomy, JJM Medical College, Davangere, Karnataka, India. 2 Assistant Professors Department of Anatomy, Sri Devaraj Urs Medical College, Kolar, Karnataka, India. 3 Professor & Head, Department of Anatomy, SSIMS & RC, Davangere, Karnataka, India. ABSTRACT Background: The obturator artery normally arises from the anterior trunk of internal iliac artery. High frequency of variations in its origin and course has drawn attention of pelvic surgeons, anatomists and radiologists. Normally, artery inclines anteroinferiorly on the lateral pelvic wall to the upper part of obturator foramen. The obturator artery may origin individually or with the iliolumbar or the superior gluteal branch of the posterior division of the internal iliac artery. However, the literature contains many articles that report variable origins. Interesting variations in the origin and course of the principal arteries have long attracted the attention of anatomists and surgeons. Methods: 50 adult human pelvic halves were procured from embalmed cadavers of J.J.M. Medical College and S.S.I.M.S & R.C, Davangere, Karnataka, India for the study. Results: The obturator artery presents considerable variation in its origin. It took origin most frequently from the anterior division of internal iliac artery in 36 specimens (72%). Out of which, directly from anterior division in 20 specimens (40%), with ilio-lumbar artery in 5 specimens (10%), with inferior gluteal artery in 3 specimens (6%), with inferior vesical artery in 2 specimens (4%), with middle rectal artery in 1 specimen (2%), with internal pudendal artery in 4 specimens (8%) and with uterine artery in 1 specimen (2%). -
Case Report-Iliac Artery.Pdf
Internal iliac artery variations Rev Arg de Anat Clin; 2012, 4 (1): 25-28 __________________________________________________________________________________________ Case report VARIATIONS IN THE BRANCHING PATTERN OF THE INTERNAL ILIAC ARTERY IN AN ADULT MALE – A CASE REPORT Satheesha Nayak B*, Srinivasa Rao Sirasanagandla, Narendra Pamidi, Raghu Jetti Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal University, Manipal, Udupi District, Karnataka State, India RESUMEN INTRODUCTION Variaciones en el patrón de ramificación de la arteria ilíaca interna son ocasionalmente encontradas en las Internal iliac artery is one of the terminal disecciones cadavéricas y las cirugías. Algunas de las branches of the common iliac artery. It supplies variaciones son de importancia quirúrgica y clínica e the organs of the pelvis and the proximal part of ignorarlas podría derivar en alarmantes sangrados the thigh, the gluteal region and the perineum. A durante las prácticas quirúrgicas. Evaluamos las number of complications can be caused when the variantes en el patrón de la arteria ilíaca interna en un cadáver masculino. La división de la arteria ilíaca artery or its branches are damaged during interna dio origen a las arterias rectal media y surgery. The complications include buttock obturatriz. La arteria vesical superior tenía su origen claudication, sexual dysfunction, colon ischemia, en la arteria obturatriz. La división posterior de la and distal spinal cord infarction and gluteal arteria ilíaca interna dio lugar a las arterias iliolumbar, necrosis. Normally the artery divides into anterior sacra lateral, glútea superior y pudenda interna. La and posterior divisions. The anterior division in arteria glútea inferior estaba ausente. males gives superior vesical, inferior vesical, Palabras clave: Arteria ilíaca interna; vasos pélvicos; middle rectal, obturator, internal pudendal and arteria glútea inferior; arteria obturatriz; arteria vesical inferior gluteal arteries. -
INTERNAL ILIAC ARTERY CLASSIFICATION and ITS CLINICAL SIGNIFICANCE Waseem Al Talalwah1, Roger Soames2
Internal iliac artery classification Rev Arg de Anat Clin; 2014, 6 (2): 63-71 __________________________________________________________________________________________ Original communication INTERNAL ILIAC ARTERY CLASSIFICATION AND ITS CLINICAL SIGNIFICANCE Waseem Al Talalwah1, Roger Soames2 1 Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz, University for Health Sciences, Riyadh, Saudi Arabia 2Centre for Anatomy and Human Identification, College of Art, Science and Engineering, University of Dundee, Dundee, United Kingdom RESUMEN the internal iliac branches to avoid iatrogenic trauma and postsurgical complications, as well as to improve En estudios anteriores de la arteria ilíaca interna se la patient management. ha clasificado en cinco tipos; sin embargo en base a una revisión de estos estudios parece que no hay una Keyword: Internal iliac artery, pelvic artery, sciatic clasificación asociada en coexistencia con una arteria artery, pelvic angiography. ciática. En este estudio, basado en la disección de 171 cadáveres (92 hombres y 79 mujeres), en 65 especímenes del tipo de la arteria ilíaca interna no podía ser clasificada debido a la presencia de una INTRODUCTION arteria ciática o ausencia de la arteria glútea inferior. Por lo tanto, se propone un sistema de clasificación modificado, ya que es esencial para los radiólogos, An early description of the internal iliac artery cirujanos ortopédicos, obstetras, ginecólogos y divisions classified branches in the pelvic wall, urólogos, para ser capaces de reconocer la pelvic viscera and extrapelvic branches based on organización de las principales ramas de las ramas their terminal course (Herbert, 1825). Later, ilíacas internas y evitar el trauma iatrogénico y las Power (1862) presented the simpler classification complicaciones postquirúrgicas, así como mejorar el of internal and external branches according to manejo del paciente. -
Bilateral Branching Variants of Internal and External Iliac Arteries - Cadaveric Study
CASE REPORT Eur. J. Anat. 24 (1): 63-68(2020) Bilateral branching variants of internal and external iliac arteries - cadaveric study Bijo Elsy, Mansour A. Alghamdi, Lina E.S. Osman Department of Anatomy, College of Medicine, King Khalid University, Abha, Saudi Arabia SUMMARY olumbar, lateral sacral and the superior gluteal arteries (Williams et al., 1995). The internal iliac During a routine female cadaveric dissection, we arteries have multiple variations in the origin of its found an unusual bilateral pelvic branching pattern branches. Arterial branching pattern variation may of the internal and external iliac arteries. The vagi- be due to developmental anomalies, hemodynamic nal and middle rectal arteries had a common origin forces, genetic predisposition and intrauterine po- from the right internal pudendal artery. An aberrant sition of the fetus (Kumari and Gowda, 2016). obturator artery arises from both external iliac ar- The external iliac artery usually gives two main teries. A right aberrant obturator artery gives a branches, namely the deep circumflex iliac and the small branch to the back of the pubic bone. The left inferior epigastric arteries, and also gives small inferior epigastric artery arises from the common branches to the psoas major muscle and the trunk of the external iliac artery with the aberrant neighboring lymph nodes (Nayak, 2008). obturator artery. Knowledge of arterial variations helps to reduce the internal hemorrhage during CASE REPORT abdominal and pelvic surgeries. We have observed bilateral variations in the in- Keywords: Aberrant obturator artery – External ternal and external iliac arteries of a female cadav- iliac artery – Internal iliac artery – Middle rectal ar- er of unknown age during a routine dissection in tery – Vaginal artery the Anatomy Department of King Khalid University, Abha, Saudi Arabia. -
ARTERIES and VEINS of the INTERNAL GENITALIA of FEMALE SWINE Missouri Agricultural Experiment Station, Departments Ofanimal Husb
ARTERIES AND VEINS OF THE INTERNAL GENITALIA OF FEMALE SWINE S. L. OXENREIDER, R. C. McCLURE and B. N. DAY Missouri Agricultural Experiment Station, Departments of Animal Husbandry and School of Veterinary Medicine, Department of Veterinary Anatomy, Columbia, Missouri, U.S.A. {Received 22nd May 1964) Summary. The angioarchitecture of the internal genitalia of twenty-six female swine was studied. The arteries of the genitalia of female swine anastomose freely allowing fluid injected into one artery to flow into all other arteries of the genitalia. A similar degree of anastomosis exists in the veins. There is no branch to the uterine horn from the so-called utero- ovarian artery and a more descriptive name for the artery would be ovarian. Also, it is more appropriate to refer to the artery originating from the umbilical artery as the uterine instead of middle uterine artery since it supplies the entire uterine horn and there is no cranial uterine artery in the pig. The uterine branch of the urogenital artery supplies the cervix and uterine body. Two large veins are located bilaterally in the mesometrium of the uterus. The larger is nearer the uterine horn, runs the entire length of the horn and is a utero-ovarian vein. It follows the ovarian artery after receiving one or two venous branches from the ovary. An additional large vein which parallels the utero-ovarian vein in the mesometrium is designated as the uterine vein since it follows the uterine artery. The uterine vein anastomoses with the utero-ovarian vein through one large branch and many smaller branches and enters a ureteric vein as the uterine artery crosses the ureter. -
Step-By-Step Ligation of the Internal Iliac Artery
Review This article will be credited by TMA within the scope of CME/CPD. 123 Step-by-step ligation of the internal iliac artery İlker Selçuk1, Bora Uzuner2, Erengül Boduç2, Yakup Baykuş3, Bertan Akar4, Tayfun Güngör1 1Clinic of Gynecologic Oncology, Health Sciences University, Zekai Tahir Burak Woman’s Health Training and Research Hospital, Ankara, Turkey 2Department of Anatomy, Kafkas University Faculty of Medicine, Kars, Turkey 3Department of Obstetrics and Gynecology, Kafkas University Faculty of Medicine, Kars, Turkey 4Clinic of Obstetrics and Gynecology, VM Medical Park Kocaeli Hospital, Kocaeli, Turkey Abstract The internal iliac artery is the main vascular supply of pelvic visceral structures. All pelvic surgeons must know the anatomic landmarks and basic steps of internal iliac artery ligation in order to stop massive pelvic hemorrhage. This cadaveric demonstration and clinical review of the internal iliac artery shows the anatomic landmarks and basic steps of internal iliac artery ligation. (J Turk Ger Gynecol Assoc 2019; 20: 123-8) Keywords: Gynecologic, hypogastric, bleeding, postpartum, pelvic Received: 8 October, 2018 Accepted: 28 November, 2018 Introduction is the principal vascular supply to provide re-vasculature to the IIA. Anastomosis between the medial femoral circumflex The anatomy of the internal iliac artery (IIA) has been well and obturator artery, and the lateral femoral circumflex and documented previously and it is the major blood supply of superior gluteal artery are the main connection areas (8). pelvic structures. It arises from the common iliac artery and Additionally, the ovarian artery also provides blood flow to the runs infero-medially in the pelvis. An enormous number of uterus. -
Variability of the Obturator Artery with Its Surgical Implications
Original article http://dx.doi.org/10.4322/jms.090015 Variability of the obturator artery with its surgical implications TAJRA, J. B. M.1*, LIMA, C. F.2, PIRES, F. R.2, SALES, L.2, JUNQUEIRA, D.2 and MAURO, E.2 1Departamento de Anatomia, Faculdade de Medicina do Planalto Central, CEP 71215-770, Brasília, DF, Brazil 2Anatomia Médica, Faculdade de Medicina do Planalto Central, CEP 71215-770, Brasília, DF, Brazil *E-mail: [email protected] Abstract The vascular anatomy of the pelvis has in the retro pubic space one the most dangerous artery variations for the surgical approach. The aim of this study was to evaluate arise from obturator artery and its implications. Eleven specimens were bisected pelvic an adult cadaver. The iliac artery and femoral artery were identified and divided in their branches. The anomalous origin was noted in 22.72% with an anastomotic branch between the external iliac or inferior epigastric vessels found in 13.69%. The right side showed a greater variation than left side with 27.27% versus 18.18%. Our data suggest that retro pubic space has critical vascular variations of the obturator artery with many probabilities of the lesions. Keywords: vascular anatomy, obturador artery, pelvis anatomy. 1 Introduction The retro pubic space has a vascular anatomy that must be The vascular anatomy of the pelvis was dissected together with known to the surgeon to avoid hemorrhagic complications. all the anatomical structures. In this region, the anomalous origin of obturator artery The internal iliac artery was identified and divided in yours (OA) and its variations are the main etiology of bleeding trunks anterior and posterior. -
The Anatomy of the Pelvis: Structures Important to the Pelvic Surgeon Workshop 45
The Anatomy of the Pelvis: Structures Important to the Pelvic Surgeon Workshop 45 Tuesday 24 August 2010, 14:00 – 18:00 Time Time Topic Speaker 14.00 14.15 Welcome and Introduction Sylvia Botros 14.15 14.45 Overview ‐ pelvic anatomy John Delancey 14.45 15.20 Common injuries Lynsey Hayward 15.20 15.50 Break 15.50 18.00 Anatomy lab – 25 min rotations through 5 stations. Station 1 &2 – SS ligament fixation Dennis Miller/Roger Goldberg Station 3 – Uterosacral ligament fixation Lynsey Hayward Station 4 – ASC and Space of Retzius Sylvia Botros Station 5‐ TVT Injury To be determined Aims of course/workshop The aims of the workshop are to familiarise participants with pelvic anatomy in relation to urogynecological procedures in order to minimise injuries. This is a hands on cadaver course to allow for visualisation of anatomic and spatial relationships. Educational Objectives 1. Identify key anatomic landmarks important in each urogynecologic surgery listed. 2. Identify anatomical relationships that can lead to injury during urogynecologic surgery and how to potentially avoid injury. Anatomy Workshop ICS/IUGA 2010 – The anatomy of the pelvis: Structures important to the pelvic surgeon. We will Start with one hour of Lectures presented by Dr. John Delancy and Dr. Lynsey Hayward. The second portion of the workshop will be in the anatomy lab rotating between 5 stations as presented below. Station 1 & 2 (SS ligament fixation) Hemi pelvis – Dennis Miller/ Roger Goldberg A 3rd hemipelvis will be available for DR. Delancey to illustrate key anatomical structures in this region. 1. pudendal vessels and nerve 2.