The Pelvis

In the Trendelenburg position, by displacing the small bowel contents into the upper abdomen, the pelvic contents may be inspected. Often it is surprising how well the pelvis may be seen as compared with open surgery, and part of this is attributable to the distension of the pelvis from the pneumoperitoneum. The relationship of the pelvic vessels to the organs is seen, and the inguinal areas are also visualized in a manner not often appreciated during conventional surgery (Figure 7.16). In female patients, Douglas pouch can be clearly observed by gently lifting up the uterus with an atraumatic grasper (Figure 7.17). The ovary can be further inspected by lifting it with the tip of the instrument (Figure 7.18). Once the rectum is mobilized, the relationships between pelvic nerves, the ureters, gonadal vessels, and the anterior structures can be appreciated, especially in less obese patients. During rectal surgery, even the pelvic floor can be well visualized in a detailed manner not often seen with conventional surgical methods (Figure 7.19).

Relationship Uterus Ureter

Figure 7.17. A

broad view of the pelvis is seen during laparoscopy in women.

U, uterus; DP, Douglas pouch; O, left ovary; R, rectum; SC, sigmoid colon; U, right ureter.

Figure 7.16. In the left inguinal region, the relationships of the gonadal vessels, vas deferens, and the major vessels exiting into the left leg are well appreciated during laparoscopy. GV, gonadal vessels; IIR, internal inguinal ring; EIA, external iliac artery; EIV, external iliac vein; Vd, vas deferens.

Figure 7.17. A

broad view of the pelvis is seen during laparoscopy in women.

U, uterus; DP, Douglas pouch; O, left ovary; R, rectum; SC, sigmoid colon; U, right ureter.

Iliac Vessel Ovary
Figure 7.18. Lifting up on the right uterine adnexa permits appreciation of the relationships of these structures to the pelvis. UF, uterine fundus; O, ovary; FT, Fallopian tube; BL, broad ligament; EIA, external iliac artery.
Tenderness The Anococcygeal Ligament
Figure 7.19. After complete mobilization of the rectum, the laparoscopic view affords excellent appreciation of some of the deep pelvic structures. R, rectum; AS, anal sphincter; PF, pelvic floor; ACL, anococcygeal ligament; C, coccyx.

Was this article helpful?

0 0
Diet Tweak System

Diet Tweak System

Trying To Lose Weight Can Be Tough. But... Not Losing Weight and Gaining What You Lost Back, Sucks. If you've ever felt that no matter what you do to lose weight nothing seems to work. If you've ever felt that there has got to be some kind of a system or way to lose weight...but just have not found it yet.

Get My Free Ebook


Post a comment