Determination of a Central Avascular Triangle within the Obturator Foramen: A Radioanatomic Study.

Krystel Nyangoh Timoh,Vincent Barrau,Cyril Touboul,Arnaud Fauconnier,Vincent Delmas,Georges Bader,Rita Rezzani

doi:10.1371/journal.pone.0143642

Abstract

PurposeTo map the vascular anatomy of the obturator foramen using fixed anatomic landmarks.MethodTwenty obturator regions were dissected in 10 fresh female cadavers after vascular blue dye injection in five cadavers (50%). Furthermore, 104 obturator regions were reconstructed by angiotomodensitometry from 52 women under investigation for suspected arterial disease. The anatomy of the obturator region was mapped by measuring the distance of vascular structures from the middle of the two branches of the ischiopubic bone, which were used as fixed landmarks.ResultsThe bifurcation of the obturator artery was at a mean (SD) distance of 30.0 mm (4.5) from the middle of the ischiopubic branch (MISP). The anterior branch of the obturator vessels was 15.2 mm (10.1) from the MISP. The posterior branch of the obturator vessels was 5.5 mm (4.0) and 23.6 mm (8.7) from the middle of the outer edge of the obturator foramen (MOE) and the MISP, respectively. Using 5° and 95° percentiles of these measurements we defined a central avascular triangle.ConclusionsOur data show that, beyond inter-individual variations, a central triangular avascular area can be identified in the obturator foramen between the posterior and anterior obturator artery using fixed landmarks.

Highlights

Pelvic organ prolapse may occur in up to 50% of parous women and prolapse repair surgery is a major public health issue [1,2,3]
The bifurcation of the obturator artery was at a mean (SD) distance of 30.0 mm (4.5) from the middle of the ischiopubic branch (MISP)
Beyond inter-individual variations, a central triangular avascular area can be identified in the obturator foramen between the posterior and anterior obturator artery using fixed landmarks

Summary

Introduction

Pelvic organ prolapse may occur in up to 50% of parous women and prolapse repair surgery is a major public health issue [1,2,3]. The procedure involves the placement of an anterior transvaginal mesh which is commonly performed by a transobturator approach [5,6]. While the use of a transvaginal mesh has been shown to be both subjectively and objectively more effective than anterior colporrhaphy [4], many complications related both to the mesh and to the transobturator approach have been described [1,7,8]. The transobturator procedure involves inserting two needles in both obturator areas without visual control. Anatomic descriptions of the obturator area are available in textbooks [17], there is a lack of practical fixed surgical landmarks which could be useful for urogynecologic surgeons

Objectives

Methods

Conclusion