Pelvic anatomy and the surgeon

Excerpt

Imagine conducting a cross-country automobile journey, traversing several large cities, exploring back roads and sightseeing without an accurate map. Although the proceeding would seem to be an inconceivable folly, the idea of performing major gynecologic surgery without a thorough and precise knowledge of pelvic anatomy is no less illogical. For the majority of practicing gynecologists and gynecologic residents-in-training, the only exposure to human anatomy dates back to the gross anatomy dissection course during the first year of medical school. From that time forward the clinician's experience is limited to on-the-job dissection in the operating room on living patients during surgical procedures. The closest thing to an anatomical dissection could possibly occur when participating in radical surgical operations as part of a gynecologic oncology rotation. Another analogy might be cited in order to illustrate the difference between anatomical versus operative dissection. The former resembles a motion picture whereas the latter is more akin to viewing a series of still photographs. This analogy can be further embellished by the following example: in order to fully appreciate the course and relationships of the external iliac vessels a complete dissection and observation should be carried out from the vessels' origins at the common iliac bifurcation to the point where they cross into the thigh beneath the inguinal ligament. In practice, the chance of seeing that kind of anatomical exposure is small. …