Presentation on theme: "Avascular Spaces of the Pelvis"— Presentation transcript:
1Avascular Spaces of the Pelvis (Where the blood vessels are not!!!)
2Avascular SpacesPotential spaces—filled with fat and connective tissueEight spaces: (four midline and four lateral)Lateral spaces: Pared pararectal and paravesical spaces(both can be used to ligate hypogastrics)Midline spaces: Prevesical space, vesicouterine space,rectouterine space, retrorectal spaceEach pelvic organ can be separated from theothers by opening avascular spaces.
3Endopelvic FasciaThe endopelvic fascia is a meshwork of connective tissue and smooth muscle which connects the pelvic viscera to the pelvic side walls. It also serves as a conduit for blood vessels and nerves.The fascial planes enable skilled surgeons relatively bloodless access to the pelvic organs and pelvic floor
4The Space of Retzius (Prevesical space) Is entered by perforating the transversalis fascialower boundary: Levator ani and pubic boneupper boundary: rectus abdominisLateral boundary: levator ani, and obturator internus fascia and the Arcus tendineus fascia pelvis.ContentsPlexus of SantoriniBladder and urethraObturator canal(watch for obturator branch of external iliac)
5Vesicovaginal or Vesicouterine space Lower boundary: proximal third of the urethraUpper boundary: anterior cul-de-sacLateral boundary: pelvic side wall and broad and cardinal ligamentsPosterior boundary: uterus and vaginaAnterior boundary: Bladder and proximal urethraContentsUreters!!!!
6Rectovaginal Space Distal boundary: perineal body Upper boundary: Posterior Cul-de –sacLateral boundaries: fascia of the levator ani and uterosacral ligamentsFloor : Coccygeus muscleAnterior boundary: vaginal muscularisPosterior boundary: rectal muscularisContentsRectal pillarsSacrospinous ligamentsUtero sacral ligaments
7Retrorectal Space (pre sacral space) Upper border: bifurcation of the aortaLower border: sacrumLateral border: internal iliac arteriesContentsMiddle sacral vesselsLateral sacral vesselsPresacral nerves
8Bilateral Paravesical Spaces Lower border: fascia of the levator AniMedial border: Obliterated Hypogastric arteryLateral border: external iliac arteryPosterior border: Broad ligamentAnterior border: Pubic symphysisContentsHypogastric arteryUreter
10Caution Hazardous areas !!! Prevesical space: injury to Plexus of Santorini, obturatorvessels or nerve (Corona mortis)Vesicovaginal space: injury to the bladder or urethraRectovaginal space: damage to the rectosigmoid,Retro rectal space: injury to the aorta or common iliacs, middle orlateral sacral vessels, nerve plexus injuryParavesical spaces: injury to the bladder, or broad ligament externaliliac vessels (vein), obturator vessels or nerves, ureterPararectal spaces: injury to ureter, hypogastic vessels (vein)