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Anatomy Objectives
I. Anterior Abdominal Wall –
Clinical Correlates: Laparoscopy, Positioning/Nerve Injury, Incisions
A. Understand the layers of the anterior abdominal wall
B. Identify the umbilical folds/ligaments and their relative structures
C. Identify major blood vessels, their origin and course
D. Identify nerves of anterior abdominal wall and their course
E. Safe zones for trochar insertion in laparascopic surgery
F. Review pfannensteil incision, vessels and nerves of concern
G. Review midline incision – anterior/posterior rectus sheath
H. Review mode of common nerve injury
I. Review laparoscopic instruments
Tag the following structures:
1. External oblique muscle
2. Internal oblique muscle
3. Rectus abdominis muscle
4. Transversus abdominis muscle
5. Transversalis fascia
6. Pyramidalis muscle
7. Thoracoabdominal nerves
8. Iliohypogastric nerve
9. Ilioinguinal nerve
10. Inferior epigastric artery
11. Superficial epigastric artery
12. Superficial circumflex artery
13. Median umbilical fold – urachus
14. Medial umbilical folds – obliterated umbilical arteries
15. Lateral umbilical folds – inferior epigastric artery & veins
16. Superficial inguinal ring
17. Inguinal ligament
18. Round ligament (as it comes through the superficial inguinal ring)
19. Lacunar ligament
20. Inguinal canal and bundle (name them)
21. Arcuate line
22. Femoral sheath
23. Deep inguinal ring
II. Abdominal/Pelvic Cavity
Clinical Correlates: C/S, Oncology cases
A. Identify major pelvic viscera and their blood supply
B. Pelvic Spaces and procedures related to them
C. Identify landmarks and points of entry for lymph node dissections
D. Enter and identify major structures in the presacral space: review
placement of sutures for ASC, and ligation of plexus for neurectomy.
E. Review the major branches off the aorta
F. Trace the path of the ureter – review risk zones
G. Identify pelvic support; Cardinal ligament, Uterosacral ligaments
H. Dissect and identify the branches of the internal iliac – both divisions;
review placement of sutures for hypogastric artery ligation
I. Review portions of tube involved in ectopic pregnancy, tubal ligations
J. Review the steps of hysterectomy
K. Review the steps of appendectomy
Tag the following structures:
1. Uterus
2. Fallopian tube – interstitial, isthmus, ampulla, infundibulum
3. Fimbria
4. Mesosalpinx
5. Mesoovarium
6. Ovary
7. Broad ligament
8. Greater omentum
9. Lesser omentum
10. Appendix
11. Vesicovaginal space
12. Prevesical space
13. Rectovaginal space
14. Retrorectal space
15. Pararectal space
16. Paravaginal space
17. Presacral space
18. Cardinal ligament
19. Uterosacral ligament
20. Renal a/v
21. Ovarian a/v
22. Inferior mesenteric a.
23. Left colic a.
24. Sigmoid a.
25. Middle sacral a.
26. Superior hypogastric plexus
27. Lumbar a.
28. Common iliac a./v
29. External iliac a/v
30. Internal iliac a/v
31. Superior gluteal a
32. Lateral sacral a
33. Iliolumbar a.
34. Umbilical a.
35. Obturator a.
36. Vaginal a.
37. Uterine a.
38. Middle hemorrhoidal a.
39. Internal pudendal a.
40. Inferior gluteal a.
41. Ureter (3 points in its course)
42. Inferior hemorrhoidal a.
43. Inf/superior vesical a.
44. Bladder trigone
45. Nodal tissue (paraaortic – ext/int iliac – obturator)
46. Wertheim tunnel
III. Pelvic Floor
Clinical Correlates: Urogyn procedures
A. Identify the levator ani muscles; coccygeus and piriformis, obturator
B. Identify the major bony landmarks – review them on the pelvis
C. Follow the path of nerves out of the pelvis
D. Identify the arcus tendineus & coopers ligament. Review steps in
burch procedure, paravaginal repair, prolift, etc in these areas.
E. Review relationship from floor and perineum in steps for pudendal
nerve block.
F. Review TOT/ TVT
G. Review Burch and ASC
H. Review TVH
I. Review sacrospinous ligament fixation, uterosacral suspension
Tag the following structures:
1. Psoas major m.
2. Iliacus m.
3. Piriformis m.
4. Coccygeus m.
5. Levator ani m (components)
6. Obturator internus m.
7. Obturator foramen
8. Ischial spine
9. Ischial tuberosity
10. Sacral promontory
11. Lesser Sciatic Foramen
12. Greater Sciatic Foramen
13. Pudendal n.
14. Lateral femoral cutaneous n.
15. Iliohypogastric n.
16. Ilioinguinal n.
17. Genitofemoral n.
18. Femoral n.
19. Obturator n.
20. Sciatic n.
21. Cooper’s ligament
22. Cardinal ligament
23. Arcus tendineus
24. Pectineal line
IV. Perineum
Clinical correlates: OB, perineal repairs, pelvimetry
A. Review again the bony landmarks, also review them on the pelvis.
B. Identify Colles fascia and the perineal membrane. Review the
relationship of these structures to the anterior abdominal wall.
C. Identify sacrotuberous ligament, sacrospinous ligament and the
vessels & nerves that course around them.
D. Review & dissect the landmarks and structures within the genital
triangle
E. Review & dissect the landmarks and structures within the anal
triangle. Review structures injured during medial and mediolateral
episiotomy repairs.
F. Dissect out the pundendal nerve and branches. Review from this
perspective the pundendal nerve block – look transbadominally as
well.
G. Identify the ischiorectal fossa and is relationship w/ the vessels/nerves
of the pelvic cavity.
H. Review TOT and TVT entry points
Tag the following structures:
1. Ischial tuberosity
2. Ischiopubic ramus
3. Ischial spine
4. Sacrospinous ligament
5. Colles’fascia
6. Perineal membrane (inf. Fascia of urogenital diaphragm)
7. Superior fascia of urogenital diaphragm
8. Ischiorectal fossa
9. Sacrotuberous ligament
10. Ischiocavernosus muscle
11. Bulbocavernosus muscle
12. Superficial transverse perineal m.
13. Deep transverse perineal m.
14. Sphincter urethrae
15. External sphincter ani (external anal sphincter)
16. Gluteus maximus
17. Internal pudendal vessels
18. Internal pudendal n.
19. Inferior hemorrhoidal a.
20. Inferior hemorrhoidal n.
21. Perineal a. & n.
22. Posterior labial a. & n.
23. Dorsal n & a. of clitoris
24. Bartholin’s gland
25. Pubourethral ligament
26. Inferior gluteal a.