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- Title
Vascular surgical anatomy of the presacral space and its relation to pelvic diameters.
- Authors
Tanrıverdi, Merve Didem Eşkin; Yılmaz, Mehmet; Cömert, Ayhan
- Abstract
Objective: Sacral colpopexy remains highly effective for repairing prolapsed vaginal apex and enterocele. Surgeons take great care to cautiously open presacral space (PSS), and expose the anterior longitudinal ligament to avoid injuring nearby vascular structures. In this study, vascular elongations were identified, and measurements were correlated to mitigate the risk of vascular injury and bleeding in regional surgeries. Methods: In our study, 10adult cadavers were utilized. The distances between the anterior superior iliac spines (disASIS), and between the common iliac vessels, promontory and the middle sacral arter (MSA) were evaluated. The MSA's position was assessed relative to the midline of the promontory (mP). The transverse, oblique and true conjugate diameters were also assessed. Results: The mean measurements of transverse, right-left oblique, and conjugate vera diameters were 12.58±0.54, 11.08±0.27 and 11.06±0.44, 12.26±0.62 cm respectively. The mean distances from the right-left common iliac artey-vein to mP were 21.5±2.5, 24.8±3.6 cm, and 22.2±7.4, 25.7±9.2 mm respectively. The mean disASIS was 242.29±17.10 mm. It has shown that as disASIS increases, the distance to mP also significantly increases, indicating a positive correlation. MSA was most often right lateralized, and the mean distances from mP was 3.90±0.57 mm. Conclusion: During surgery, understanding and maintaining anatomical balance in the pelvis contribute to improving the patient's quality of life. The vascular pattern within PSS varies, with major vessels often deviating significantly from their expected positions. Surgeons should meticulously expose structures within this space before proceeding to place sutures during sacral colpopexy. Since disASIS is positively correlated with the, common iliac vessels, and MSA, it may be advisable for the surgical team to approach cases with narrow disASIS more cautiously to minimize vascular injuries.
- Subjects
SURGICAL &; topographical anatomy; SACRUM; ANTERIOR longitudinal ligament; DIAMETER; QUALITY of life; HERNIA
- Publication
Anatomy: International Journal of Experimental & Clinical Anatomy, 2024, Vol 18, pS10
- ISSN
1307-8798
- Publication type
Abstract