Abstract
The surgical treatment of gynecological malignancies is, except for tumors diagnosed at the earliest stages and patients’ desire for fertility preservation, not limited to only the affected organ. In cases of metastatic iliac lymph nodes, gynecological tumors or recurrences located near the pelvic sidewall, oncogynecologists should dissect tissues in that region. Moreover, surgery of deep infiltrating endometriosis, e.g., within the sacral plexus, or oncological procedures, such as a laterally extended endoplevic resection or a laterally extended parametrectomy, often require a dissection of the pelvic sidewall. Dissection should be meticulous, and detailed knowledge of anatomy is mandatory. There are many controversies among authors regarding the terminology in the pelvic sidewall. In particular, several imprecise or confusing definitions exist in regard to the region located medially to the psoas major muscle. Therefore, after discussing the anatomy of the pelvic sidewall and the commonly used terminology, we define a new term and boundaries of a potential avascular space, the medial psoas space. Contrary to the variety of earlier definitions, the proposed boundaries relate to a truly avascular space and could help surgeons to avoid complications resulting from misleading anatomical descriptions. Additionally, describing the clear boundaries of and possible anatomical variations in the medial psoas space may urge oncogynecologists to consider different approaches during surgery. The purpose of the present study is to describe the anatomy of the pelvic sidewall and the applications of the medial psoas space in gynecologic oncology.
Highlights
The surgical treatment of gynecological malignancies is, except for tumors diagnosed at the earliest stages and patients’ desire for fertility preservation, not limited to only the affected organ [1]
The aims of the present study were: an accurate description of the pelvic sidewall (PSW) anatomy suitable for the gyneco-oncological approach; a clear delineation of a useful avascular space, the medial psoas space (MPS), which has been inconsistently defined in the literature; and the standardization of the PSW dissection technique based on an accurate anatomical description
For the remaining nine patients, six underwent pelvic lymphadenectomy followed by total abdominal hysterectomy, three of them for non-endometrioid endometrial cancer, and the other half for pelvic bulky lymph nodes due to ovarian cancer
Summary
The surgical treatment of gynecological malignancies is, except for tumors diagnosed at the earliest stages and patients’ desire for fertility preservation, not limited to only the affected organ [1]. Depending on the stage and histology of a tumor, a lymph node dissection is often performed in gynecologic oncology [2]. In cases of bulky metastatic lymph nodes, gynecological tumors or recurrences located near the pelvic sidewall, oncogynecologists should dissect tissues in that region [3,4]. After discussing the anatomy of the PSW and the commonly used anatomical terminology, we define a new term and boundaries of a potential avascular space, the medial psoas space. The aims of the present study were: an accurate description of the PSW anatomy suitable for the gyneco-oncological approach; a clear delineation of a useful avascular space, the medial psoas space (MPS), which has been inconsistently defined in the literature; and the standardization of the PSW dissection technique based on an accurate anatomical description
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