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.
Highlights
The term “spaces” refers to the areas delimited by at least two independent fasciae and filled with areolar connective tissue
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 [2,3]
We describe the fourth space and separate the paravesical and pararectal space, as nerve-sparing gynecological procedures request a precise understanding of retroperitoneal spaces
Summary
The term “spaces” refers to the areas delimited by at least two independent fasciae and filled with areolar connective tissue These spaces could be exposed by separating two independent fasciae along their cleavage plane [1,2]. Three pairs of ligaments divide the retroperitoneal spaces [1,4] These spaces are avascular and filled with fatty or loose areolar connective tissues [5]. Retroperitoneal spaces exist as the pelvic viscera are derived from different embryologic structures Developing these spaces early during an operation exposes vital structures and avoids injuring the viscera, ureter, nerves, and blood vessels [1,4,5,6]. A noteworthy fact is that for various gynecological diseases, there are different approaches to the avascular spaces of the female pelvis [7]. We describe the fourth space and separate the paravesical and pararectal space, as nerve-sparing gynecological procedures request a precise understanding of retroperitoneal spaces
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