Gynecologic Surgery Workshop, INASMEET 2023, 11-12 December 2023, Surabaya

Clinical Anatomy of The Pelvis

Dr. dr. Unedo Hence Markus Sihombing, SpOG, Subsp. Onk
Tarakan Hospital Jakarta
Anterior Abdominal Wall
THERE ARE 12 LAYERS IN OUR ABDOMEN
REGION

https://www.osmosis.org
Complication
Surgery
1. Infection (Burst Abdoment)
2. Tension
3. Pain
4. Dehisence Good Result
5. Scarr
6. Hipoestesia 1. Good Healing
(minimal scar, no infection)
2. No Tension
3. No Pain
INTRA ABDOMEN
ORGANS

1.INTRA-PERITONEAL
2.RETROPERITONEAL

Cunningham F, & Leveno K.J., & Dashe J.S., & Hoffman B.L., & Spong
C.Y., & Casey B.M.(Eds.), (2022). Williams Obstetrics, 26e. McGraw Hill.
Intra abdomen/
Organs
Intraperitoneal :
1.Reproductive
Organ
2. Intertinal Organ
3. Varcular

Retroperitoneal :
1.ureter
2. Vascular
3. Ren

Cunningham F, & Leveno K.J., & Dashe J.S., & Hoffman B.L., & Spong C.Y., & Casey
B.M.(Eds.), (2022). Williams Obstetrics, 26e. McGraw Hill.
Cunningham F, & Leveno K.J., & Dashe J.S., & Hoffman B.L., & Spong C.Y., & Casey
B.M.(Eds.), (2022). Williams Obstetrics, 26e. McGraw Hill.

Structur of Vessel

Lateral view Anterior view

 VASCULARIZATION

Uterina

Selçuk, I., Yassa, M., Tatar, I., & Huri, E. (2018). Anatomic structure of the internal iliac artery and its educative dissection for
peripartum and pelvic hemorrhage. Turkish Journal of Obstetrics and Gynecology, 15, 126 - 129.
 Vascularization

Cunningham F, & Leveno K.J., & Dashe J.S., & Hoffman B.L., & Spong C.Y., & Casey
B.M.(Eds.), (2022). Williams Obstetrics, 26e. McGraw Hill.
 ARTERY COMMUNAL
IMAGINE ILLIAC

THE STRUCTURE
URETER

ARTERY INTERNAL ILLIAC

(HYPOGASTRIC ARTERY)
• ARTERY EXTERNAL ILLIAC
COMMUNAL ILLIAC VEIN
• Internal Illiac Artery ligation
• Occlusion = decreases mean
blood flow by 48%
• Slows haemorrhageà allow
identification of the specific
bleeding sites
• Does not compromise the
pelvic organ viability
Cunningham F, & Leveno K.J., & Dashe J.S., & Hoffman B.L., & Spong C.Y., & Casey
B.M.(Eds.), (2022). Williams Obstetrics, 26e. McGraw Hill.
 Ligation of the internal iliac artery
• Through the round • Through pouch of
ligament douglas

Jyothi G. Internal Iliac Artery Ligation: A Retrospective Analysis of Two Different

 Retroperitoneal access procedure
(round ligament)

Jyothi G. Internal Iliac Artery Ligation: A Retrospective Analysis of Two Different

Approaches. J South Asian Feder Obs Gynae 2017; 9 (3):230-234.
 Retroperitoneal access procedure
(pouch of douglas)

Jyothi G. Internal Iliac Artery Ligation: A Retrospective Analysis of Two Different

Approaches. J South Asian Feder Obs Gynae 2017; 9 (3):230-234.
Vascularization

Ligation here

Ciarmela, P et al. Uterine fibroid

vascularization: from morphological
evidence to clinical implications.
(2022). Reproductive BioMedicine
Online, 44(2), 281-294.
 ACCESS TO
RETROPERITONEAL
SPACE

Open round ligament

↓

Look at local area

retroperitoneal
Desection ; Mucous, fibrous
and Fat tissue
↓

Identification : ureter, artery

(Bivuartyo, internal & ekternal
iliac artery & vena)

Unedo’s collection
Access of internal iliac artery

•VASCULARIZATION INSIDE OF
RETROPERITONEAL SPACE
•1. ARTERY COMMUNAL ILLIAC
• ARTERY EXTERNAL ILLIAC
• ARTERY INTERNAL ILLIAC
(HYPOGASTRIC ARTERY)
•2. COMMUNAL ILLIAC VEIN
•3. URETER
•4. LYMPH NODE
Right side pelvic
Unedo’s collection
TIPS AND TRICKS

Left side pelvic

Unedo’s collection
 Thank You
CP : Dr Unedo (HP: 08122637874)