1. Avascular Spaces of the Pelvis
(Where the blood vessels are not!!!)

2. Avascular Spaces
Potential spaces—filled with fat and connective tissue
Eight 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 space
Each pelvic organ can be separated from the
others by opening avascular spaces.

3. Endopelvic Fascia
The 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

4. The Space of Retzius (Prevesical space)
Is entered by perforating the transversalis fascia
lower boundary: Levator ani and pubic bone
upper boundary: rectus abdominis
Lateral boundary: levator ani, and obturator internus fascia and the Arcus tendineus fascia pelvis.
Contents
Plexus of Santorini
Bladder and urethra
Obturator canal(watch for obturator branch of external iliac)

5. Vesicovaginal or Vesicouterine space
Lower boundary: proximal third of the urethra
Upper boundary: anterior cul-de-sac
Lateral boundary: pelvic side wall and broad and cardinal ligaments
Posterior boundary: uterus and vagina
Anterior boundary: Bladder and proximal urethra
Contents
Ureters!!!!

6. Rectovaginal Space Distal boundary: perineal body
Upper boundary: Posterior Cul-de –sac
Lateral boundaries: fascia of the levator ani and uterosacral ligaments
Floor : Coccygeus muscle
Anterior boundary: vaginal muscularis
Posterior boundary: rectal muscularis
Contents
Rectal pillars
Sacrospinous ligaments
Utero sacral ligaments

7. Retrorectal Space (pre sacral space)
Upper border: bifurcation of the aorta
Lower border: sacrum
Lateral border: internal iliac arteries
Contents
Middle sacral vessels
Lateral sacral vessels
Presacral nerves

8. Bilateral Paravesical Spaces
Lower border: fascia of the levator Ani
Medial border: Obliterated Hypogastric artery
Lateral border: external iliac artery
Posterior border: Broad ligament
Anterior border: Pubic symphysis
Contents
Hypogastric artery
Ureter

9. Bilateral Pararectal Spaces
Floor: coccygeus muscle
Medial boundary: Ureter
Lateral boundary: hypogastric artery
Anterior boundary: broad ligament
Posterior boundary: sacrum
Contents
Ureter
Hypogastric artery

10. Caution Hazardous areas !!!
Prevesical space: injury to Plexus of Santorini, obturator
vessels or nerve (Corona mortis)
Vesicovaginal space: injury to the bladder or urethra
Rectovaginal space: damage to the rectosigmoid,
Retro rectal space: injury to the aorta or common iliacs, middle or
lateral sacral vessels, nerve plexus injury
Paravesical spaces: injury to the bladder, or broad ligament external
iliac vessels (vein), obturator vessels or nerves, ureter
Pararectal spaces: injury to ureter, hypogastic vessels (vein)