Surgical anatomy of the pectineal ligament during pectopexy surgery: The relevance to the major vascular structures
ÇİĞDEM PULATOĞLU1, ozan doğan2, Mahmut Sabri Medisoğlu3, MURAT YASSA4, AŞKI ELLİBEŞ KAYA5, ilker Selcuk6, Rahime Nida Bayık71Department of Obstetrics and Gynecology, Istinye University Hospital Gaziosmanpaşa Medical Park, Istanbul, Turkey2Department of Obstetrics and Gynecology, Private Clinic, Istanbul, Turkey
3Department of Anatomy, Gölcük District Health Directorate, Gölcük, Turkey
4Department of Obstetrics and Gynecology, Sancaktepe Şehit Professor İlhan Varank Training And Research Hospital, Istanbul, Turkey
5Department of Obstetrics and Gynecology, Duzce University Hospital, Duzce, Turkey
6Department of Gynecologic Oncology, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey / Department of Anatomy, Hacettepe University Faculty of Medicine, Ankara, Turkey
7Department of Obstetrics and Gynecology, Health Sciences University, Göztepe Research and Training Hospital, Istanbul, Turkey
Objective: During pectopexy surgery, the prolapsed uterus or the vaginal apex is fixed to the pectineal ligament. The anatomical structures found lateral part of prevesical and paravaginal space above the obturator fossa, raise the importance of the surgical steps to prevent complications. This study is conducted to evaluate the proximity of vascular structures to the pectineal ligament.
Material and Methods: The distances between the surgical suturing area during pectopexy surgery and the external iliac vein, pubic anastomotic vessel(corona mortis) and obturator canal were measured bilaterally in 7 fresh female cadavers.
Results: The total length of pectineal ligament was 5.9±0.76cm on the left and 6.5±1.14cm on the right side; the midpoint of the pectineal ligament was 2.8±0.52 cm on the left and 3.6±0.47 cm on the right side. From the midpoint of the left pectineal ligament, the mean distance to the left external iliac vein was 1.04±0.23cm, to the left corona mortis was 2.15±0.48cm and to the left obturator canal was 3.12±0.95cm. From the midpoint of the right pectineal ligament, the mean distance to the right external iliac vein was 1.25±0.43cm, to the right corona mortis was 2.37±0.63 cm and to the right obturator canal was 3.57±0.93 cm.
Conclusions: The anatomical findings of the study confirmed that the pectineal ligament was in close association with main vessels. External iliac vein was measured as the closest anatomical structure to the pectineal ligament. The surgeons must be careful to minimize life-threatening complications because of the proximity of pectineal ligament to main vessels.
Surgical anatomy of the pectineal ligament during pectopexy surgery: The relevance to the major vascular structures
ÇİĞDEM PULATOĞLU1, ozan doğan2, Mahmut Sabri Medisoğlu3, MURAT YASSA4, AŞKI ELLİBEŞ KAYA5, ilker Selcuk6, Rahime Nida Bayık71İstinye Üniversitesi Gaziosmanpaşa Medical Park Hastanesi, Kadın Hastalıkları ve Doğum Kliniği, İstanbul, Türkiye2Özel Klinik, Kadın Hastalıkları ve Doğum Kliniği, İstanbul, Türkiye
3Gölcük İlçe Sağlık Müdürlüğü, Anatomi Anabilim Dalı, Gölcük, Türkiye
4Sancaktepe Şehit Profesör İlhan Varank Eğitim Ve Araştırma Hastanesi, Kadın Hastalıkları ve Doğum Kliniği, İstanbul, Türkiye
5Düzce Üniversitesi Hastanesi, Kadın Hastalıkları ve Doğum Kliniği, Düzce, Türkiye
6Ankara Bilkent Şehir Hastanesi, Sağlık Bilimleri Üniversitesi, Jinekolojik Onkoloji Kliniği, Ankara, Türkiye / Hacettepe Üniversitesi Tıp Fakültesi, Anatomi Anabilim Dalı, Ankara, Türkiye
7Sağlık Bilimleri Üniversitesi, Göztepe Eğitim ve Araştırma Hastanesi, Kadın Hastalıkları ve Doğum Kliniği, İstanbul, Türkiye
Objective: During pectopexy surgery, the prolapsed uterus or the vaginal apex is fixed to the pectineal ligament. The anatomical structures found lateral part of prevesical and paravaginal space above the obturator fossa, raise the importance of the surgical steps to prevent complications. This study is conducted to evaluate the proximity of vascular structures to the pectineal ligament.
Material and Methods: The distances between the surgical suturing area during pectopexy surgery and the external iliac vein, pubic anastomotic vessel(corona mortis) and obturator canal were measured bilaterally in 7 fresh female cadavers.
Results: The total length of pectineal ligament was 5.9±0.76cm on the left and 6.5±1.14cm on the right side; the midpoint of the pectineal ligament was 2.8±0.52 cm on the left and 3.6±0.47 cm on the right side. From the midpoint of the left pectineal ligament, the mean distance to the left external iliac vein was 1.04±0.23cm, to the left corona mortis was 2.15±0.48cm and to the left obturator canal was 3.12±0.95cm. From the midpoint of the right pectineal ligament, the mean distance to the right external iliac vein was 1.25±0.43cm, to the right corona mortis was 2.37±0.63 cm and to the right obturator canal was 3.57±0.93 cm.
Conclusions: The anatomical findings of the study confirmed that the pectineal ligament was in close association with main vessels. External iliac vein was measured as the closest anatomical structure to the pectineal ligament. The surgeons must be careful to minimize life-threatening complications because of the proximity of pectineal ligament to main vessels.
Corresponding Author: ÇİĞDEM PULATOĞLU, Türkiye
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