Lateral Transperitoneal Accesses to the Pelvic Retroperitoneum in Gynecology: Surgical Technique, Anatomical Landmarks and Variations

Abstract

The retroperitoneum in the pelvis includes all pelvic spaces (Retzius’, vesicocervical/vesicovaginal, rectovaginal, presacral, pararectal and paravesical) and vital structures such as nerves, vessels, lymph nodes and ureters. Eradication of endometriosis, myomectomy of intraligamentary myoma, urogynecological reconstructive and oncological exenterative surgery require wider anatomical knowledge in the retroperitoneum. Generally, the retroperitoneal space is used for plane of dissection when the peritoneal cavity is obliterated. In the medical literature, there are few articles reporting the important relationship between retroperitoneal accesses, anatomical landmarks and anatomical variations in surgery. In the present article, lateral transperitoneal accesses to the pelvic retroperitoneum by open surgery are discussed. Furthermore, anatomical landmarks and anatomical variations encountered during retroperitoneal dissection are analyzed. Providing comprehensive knowledge of lateral transperitoneal accesses to the pelvic retroperitoneum will decrease patient’s morbidity and mortality. The recognition of retroperitoneal anatomical landmarks and anatomical variations will give surgeons more confidence. They should be familiar with anatomical variations, which are likely to occur during retroperitoneal accesses and dissection.