Transcript Avascular Spaces

Avascular Spaces
of the Pelvis
(Where the blood vessels are not!!!)
Avascular Spaces
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Potential spaces—filled with fat and connective tissue
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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
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Each pelvic organ can be separated from the
others by opening avascular spaces.
Endopelvic Fascia
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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
The Space of Retzius (Prevesical space)
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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)
Vesicovaginal or Vesicouterine space
Lower boundary:
Upper boundary:
Lateral boundary:
ligaments
Posterior boundary:
Anterior boundary:
proximal third of the urethra
anterior cul-de-sac
pelvic side wall and broad and cardinal
uterus and vagina
Bladder and proximal urethra
Contents
Ureters!!!!
Rectovaginal Space
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Distal boundary:
Upper boundary:
Lateral boundaries:
Floor :
Anterior boundary:
Posterior boundary:
perineal body
Posterior Cul-de –sac
fascia of the levator ani and uterosacral ligaments
Coccygeus muscle
vaginal muscularis
rectal muscularis
Contents
Rectal pillars
Sacrospinous ligaments
Utero sacral ligaments
Retrorectal Space (pre sacral space)
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Upper border:
Lower border:
Lateral border:
bifurcation of the aorta
sacrum
internal iliac arteries
Contents
Middle sacral vessels
Lateral sacral vessels
Presacral nerves
Bilateral Paravesical Spaces
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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
Bilateral Pararectal Spaces
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Floor:
coccygeus muscle
Medial boundary: Ureter
Lateral boundary: hypogastric artery
Anterior boundary: broad ligament
Posterior boundary: sacrum
Contents
Ureter
Hypogastric artery
Caution Hazardous areas !!!
Prevesical space:
Vesicovaginal space:
injury to Plexus of Santorini, obturator
vessels or nerve (Corona mortis)
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)