Avascular Spaces of the Female Pelvis—Clinical Applications in Obstetrics and Gynecology

Abstract

The term “spaces” refers to the areas delimited by at least two independent fasciae and filled with areolar connective tissue. However, there is discrepancy regarding the spaces and their limits between clinical anatomy and gynecologic surgery, as not every avascular space described in literature is delimited by at least two fasciae. Moreover, new spaces and surgical planes have been developed after the adoption of laparoscopy and nerve-sparing gynecological procedures. Avascular spaces are useful anatomical landmarks in retroperitoneal anatomic and pelvic surgery for both malignant and benign conditions. A noteworthy fact is that for various gynecological diseases, there are different approaches to the avascular spaces of the female pelvis. This is a significant difference, which is best demonstrated by dissection of these spaces for gynecological, urogynecological, and oncogynecological operations. Thorough knowledge regarding pelvic anatomy of these spaces is vital to minimize morbidity and mortality. In this article, we defined nine avascular female pelvic spaces—their boundaries, different approaches, attention during dissection, and applications in obstetrics and gynecology. We described the fourth space and separate the paravesical and pararectal space, as nerve-sparing gynecological procedures request a precise understanding of retroperitoneal spaces.

Anatomy of the vesicovaginal fascia and its relation to branches of the inferior hypogastric plexus

“…In another study of this region, Kostov et al (2020) described the region between the urinary bladder and the vagina as the vesicovaginal space–one of nine avascular spaces in the female pelvis. Considering that two of the dissections in our study found the VVF to be a double layer of fascia, it may be possible that the avascular space described by Kostov et al (2020) correlates with the apparently avascular plane found between these two layers. Greater clarification for this layered arrangement is needed and will require further histological studies.…”

Prophylactic ligation of uterine arteries at its origin in laparoscopic surgical staging for endometrial cancer

“…26 The internal iliac artery lies below the external iliac vein and most of the endoscopists start performing the laparoscopic standard transperitoneal lymphadenectomy over the external iliac vein and then open the paravesical/pararectal spaces for pelvic lymph node dissection. 27,28 In our technique, the paravesical/pararectal spaces were being exposed at the beginning of retroperitoneal dissection and prophylactic ligation of UA at its origin was administered. The laparoscopic standard transperitoneal lymphadenectomy over the external iliac vein performed after first attempting prophylactic ligation of UA at its origin.…”

Surgical Anatomy of Fasciae and Cellular Spaces of Subperitoneal Storey of Female Pelvis

“…Некоторые пространства используются для проведения оперативных вмешательств влагалищным доступом [7]. Стоит заметить, что в зависимости от нозологии используются различные доступы к клетчаточным пространствам женского таза [8,9]. Названия пространств происходят от наименований органов, окружающих их [8].…”

“…Последними исследованиями было доказано наличие нескольких фасциальных слоев внутри пространства Ретциуса, поэтому не совсем верно считать его единым анатомическим образованием [29]. Вдоль передней поверхности мочевого пузыря к пупку тянется пузырнопупочная или предпузырная фасция [9]. Задняя поверхность лобкового симфиза покрыта париетальной фасцией таза, которая является продолжением книзу поперечной фасции [2,10].…”