A Novel Access to the Sacrospinous Ligament and the Coccygeal Muscle
Study Objective
This study aimed to describe a novel access route to the sacrospinous ligament and the coccygeal muscle. The overarching goal was to show our team's standard systematization to this technique and state it's safety in low parametric injuries.
Design
Video description of the novel technique with clear illustrations of each step.
Setting
N/A.
Patients or Participants
The surgery was performed in a 27-year-old woman who suffered from deep endometriosis in the pelvic floor. Her diagnosis was performed through physical examination, with innervation compression symptoms, ultrasound and MRI imaging techniques.
Interventions
After the identification and release of the central structures, we proceed to the lateral approach with the isolation of the internal iliac artery, which should be medially tractioned, enabling the identification of the bifurcation of the common iliac vein into the internal and external iliac vein. We then start the systematization of the approach with the dissection of the avascular space between the "V" shape formed by the umbilical artery and uterine artery, subsequently heading towards the sacrum. Next, we identify the rectovaginal fascia, being the first structure to be identified, extending from the rectovaginal space to the tendon arch. Behind this structure, we can find the coccygeal muscle and the sacrospinous ligament extending from the sciatic spine towards the sacrococcyx.
Measurements and Main Results
We conclude the systematization of the pelvic floor approach being able to safely perform the resection of the endometriotic nodules with intact innervation, tension-free muscles and greater damage control.
Conclusion
In summary this novel approach to the pelvic floor is thought to be a simpler and less risky alternative to treat low parametric injuries afflicting the sacrospinous ligament and the coccygeal muscle.
Video Sobre anatomia cirúrgica em um caso de cirurgia de alta complexidade, por endometriose profunda com comprometimento extenso em compartimento posterior envolvendo os ligamentos utero sacros, nervos de plexo hipoástrico, parede intestinal, fundo vaginal, assoalho pélvico e paramétrio.
Este caso foi apresentando como um video abstract an AAGL (Congresso Mundial de Ginecologia Laparoscópica) demonstrando um novo acesso ao ligamento sacroespinhoso no ano de 2021 descrito pelo meu grande MESTRE Dr. CLAUDIO CRISPI
Tive a honra de ser convidado para ministrar uma aula no 47th Annual D.A. Boyes Society Meeting and Obstetrics & Gynaecology Clinical Review pela Dra Fariba Mohtashami da UBC (Unievrsity British Columbia , Vancouver _ Canada) onde preparei esta aula e hoje venho compartilhar este video com todos vocês.
- Surgical Anatomy in Complex Pelvic Surgery of Deep Endometriosis ( Download)
- 中国10个烂尾建筑，最贵一个耗资6000亿人民币！你看过哪几个？ ( Download)
- Making A Hall Table With Built In Storage ( Download)
- Visite du Château de Carneville avec son Jeune Propriétaire: Restauration, Défis et Projets de Vie. ( Download)
- Neuroanatomía - Meninges (Duramadre, Aracnoides, Piamadres) ( Download)
- Anatomía Repaso ( Download)
- WWGOA LIVE: January 2019 ( Download)
- QuarentAnato UFTM - Cabeça e Pescoço 2 (Órbita) ( Download)
- ARABESQUE stretch & strengthen class ( Download)
- Cataract, Day 1, Online PG Teaching Initiative ( Download)
- Tecnologías médicas aplicadas a la periórbita ( Download)
- Civil Technology | Gr 12 | Memo | Woodworking | FSDOE | FS IBP Online | 17092020 ( Download)
- QuarentAnato UFTM - Cabeça e Pescoço 2 ( Download)
- La nuova classificazione WHO 2020 dei tumori mesenchimali: luci ed ombre. Prof. Angelo Paolo Dei Tos ( Download)
- Reunião do Setor de Retina e Vítreo 16 03 2023 ( Download)
