Deep Inguinal Ring Research Articles

Standardization of Laparoscopic Pelvic Examination

To standardized laparoscopic pelvic examination, pelvis is topographically divided into two midline zones (zone I and II) and two paired (right and left) lateral zones (zone III and IV). Zone I is the area between the two round ligaments from their origin at the uterine cornua to their insertion in the deep inguinal rings. Zone II is the area between the two uterosacral ligaments from their origin from the back of the uterus to their insertions in the sacrum posteriorly. Zone III is the area between the uterosacral ligament inferiorly and the entire length of the fallopian tube and the infundibulo pelvic ligament superiorly.

The Anterior Abdominal Wall: A Self-Study Paper Model

OPEN ACCESSSeptember 24, 2014The Anterior Abdominal Wall: A Self-Study Paper Model Alan Sakaguchi, PhD, Maria Bartanuszova, Earlanda Williams, Charleen Moore Alan Sakaguchi, PhD University of Texas Health Science Center at San Antonio Google Scholar More articles by this author , Maria Bartanuszova University of Texas Health Science Center at San Antonio Google Scholar More articles by this author , Earlanda Williams University of Texas Health Science Center at San Antonio Google Scholar More articles by this author , Charleen Moore University of Texas Health Science Center at San Antonio Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9922 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstract Introduction: The interior abdominal wall has numerous layers that are often confusing to beginning anatomy students. Educators have noted that students learn in different ways, including kinesthetically. Assembling this simple model of a complex anatomical structure is a fun and interactive way to encourage students to transform kinesthetic experience into useful learning. Methods: Detailed templates and instructions for constructing a simple model of the anterior abdominal wall from colored paper and strings are provided to teach the layered anatomy of structures such as the anterior and posterior laminae of the rectus sheath and the arcuate line. Other features represented on the model include skin and tela subcutanea, multilayered anatomy of the musculature and aponeuroses, the inguinal ligament, and passage of structures through the deep and superficial inguinal rings. A list of features and associated teaching points are also provided, as well as examples of common clinical pathology. Students learn from assembling the model as well as from its three-dimensional nature and various colors representing different layers. Self-assessment questions are included too. All or some of the questions can be used to prepare class or self-study exercises that utilize the paper model. Suggestions are given for using the model during lectures, anatomical dissection of the anterior abdominal wall, and self-study away from the anatomy lab. Results: The model was used as a learning tool in a physician assistant gross anatomy class. Twenty-seven out of 40 students volunteered to assess the model's utility as a learning tool. These students took a brief four-question assessment before using the model and the same assessment after using it. All students except one improved on the postassessment, and none did worse. All said that the model was useful. Discussion: The model is a portable, simple, and inexpensive tool that can be used in the classroom, in the anatomy lab, or as self-study. It is not a replacement for other print or electronic study tools available to learn the anatomy of the anterior abdominal wall. It supplements, but does not replace, the study of living anatomy, prosected material, or anatomical dissection. Educational Objectives This resource will enable learners to: Use kinesthetic learning in assembling the model.Understand relationships of structures and regions of clinical significance.Use features shown on the model to understand associated teaching points.Use the model during lectures as well as during and after dissection.Use the model for peer-to-peer teaching and team-based learning activities.Use the question set for self-assessment. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Instructors Guide.pdf Wall model assembly instructions.pdf Wall model color templates.pdf Wall model templates.pdf Wall model self assessment questions.pdf Physician assistant wall model assessment.pdf To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Copyright & Permissions© 2014 Sakaguchi et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-No Derivatives license.KeywordsRectus SheathInguinal CanalAnatomical ModelArcuate LineAnterior Abdominal WallAnatomic Models Disclosures None to report. Funding/Support None to report. Prior Presentations Sakaguchi A, Bartanuszova M, Williams E, Weaker F, Moore C. Low tech can be high yield: simple but effective paper models of the anterior abdominal wall, pterygopalatine fossa, and triangles of the neck. Poster presented at: American Association of Anatomists Regional Meeting; October 12, 2013; Dallas, TX. Loading ...

Современные взгляды на хирургическую анатомию пахового канала при паховых грыжах

The purpose of this work is to study surgical anatomy in the patients with inguinal hernias of various kinds. Material. This work is performed on 41 corpses with inguinal hernias. Topographic and anatomical dissection of the inguinal canal with measurement of the linear parameters of anatomical structures, histological examination of specimens of the internal oblique abdominal muscles, the transverse fascia of the abdomen were carried out. Results. The authors have studied the structure of the posterior wall of the inguinal canal in the patients with oblique, direct, supravesical and inguinal-scrotal hernias. At persons with direct and supravesical inguinal hernias, a deformation is observed, mainly, in the medial inguinal fossa and supravesical fossa, showing great value inguinal gap, bland crescent aponeurosis, thinning of the transverse fascia of the abdomen. Increase of deep inguinal rings is observed in persons with oblique inguinal hernias. Dystrophy of abdominal muscles has always with inguinal hernias, and it is pronounced in the patients with inguinal-scrotal hernias. Conclusions. At surgical treatment of patients with direct inguinal hernias it is necessary to carry out correction of a posterior wall of the inguinal canal, in the patients with oblique inguinal hernias the anterior wall of the inguinal canal has to be surely restored. In the application of mesh materials in patients with large inguinal hernias, the results of treatment are doomed to fail, because the endoprosthesis only closes hernial wall that when failure of muscle function will clearly increase.

К вопросу об особенностях строения поперечной фасции живота у лиц разного пола, возраста и с разной формой пахового промежутка

The study was aimed at finding new structural features of the rear wall of the inguinal canal, the use of which allow to improving the prevention of inguinal hernias. The study involved 123 corpses of different sex and age. Anatomical and physiological nature of the valve mechanism inguinal canal, the peculiarities of the structure of the back wall in individuals of different sex and age were revealed; the various forms of inguinal gap were studied. Using cluster analysis of transverse fascia thickness abdominal length and height of the deep inguinal ring was one of three variants of the structure back wall of the inguinal canal: a strong, transient and weak. The technique of determining the location of the deep inguinal ring relative to the edge of the internal oblique abdominal muscles is offered. The use of this technique objectively reflects the anatomical and physiological characteristics of the inguinal canal as a whole. In interpreting the results of a valve mechanism of deep inguinal ring should be considered ineffective in the medial or medial edge of the boundary location of the deep inguinal ring relative to the internal oblique abdominal muscles. Functional and anatomical factors that contribute to the formation of inguinal hernias were identified. It is proved that the triangular shape of the inguinal gap causes a high risk of inguinal hernias. In both sexes the transverse abdominal fascia becomes thinner with age, and the deep inguinal ring increases in size. The obtained data will improve the effectiveness of preventive measures.

A novel method for assessing valvular mechanism of deep inguinal ring considering the objective topographic anatomical criteria

Aim. To develop a method to assess the valvular mechanism of deep inguinal ring based on objective topographic anatomical criteria. Methods. The research was performed on 123 native corpses of persons without pathology of the anterior abdominal wall. Morphometric examination of the inguinal canal was carried out. The shape of the inguinal gap was determined, inguinal gap and inguinal canal length was measured, as well as deep inguinal ring length and height and deep inguinal ring height. Oval fissured inguinal gap was revealed in 49 (39.8%) persons, intermediate oval - in 51 (41.5%), triangular - in 23 (18.7%). Results. The dependence of the length of the inguinal canal, inguinal gap length, deep inguinal ring size and its standing height on the inguinal gap shape was examined. The method for an objective assessment of the deep inguinal ring valvular mechanism was proposed. The method is based on determining the deep inguinal ring location in reference to the internal oblique abdominal muscles by estimating the integral rate of the inguinal canal length and the inguinal gap length and deep inguinal ring height. Three options for the deep inguinal ring location: upper lateral, lower medial and boundary location are described. Deep inguinal ring positions were determined by cluster analysis. In cases of upper lateral position, which was observed in 28 (22.8%) of cases, the valvular mechanism of deep inguinal ring was stable. In cases of deep inguinal ring lower medial position (41 cases, 33.3%), the opposite results were gained. In cases of deep inguinal ring boundary location (54 cases, 43.9%), the valvular mechanism is stable, but may become insolvent if destructive changes of the lateral abdominal muscles and deep inguinal ring expansion were present. Conclusion. An objective method of assessing the deep inguinal ring valvular mechanism, based on determining the deep inguinal ring location in reference to the oblique abdominal muscles was developed.

Scrotal enterocutaneous fistula: a rare initial presentation of inguinal hernia

We describe the case of a 70-year-old man with a long history of inguinal hernia who finally presented to the emergency department with a scrotal enterocutaneous fistula. This is a rare complication of an incarcerated/obstructed direct inguinal hernia. We performed exploratory laparotomy with resection of the perforated small bowel and end-to-end anastamosis of the ileal segment using the purse-string suture at the deep inguinal ring.

Appendicular abscess in left inguinal hernia mimicking strangulation

Introduction: the incidence of Amyand’s hernia varies from 0.5–1%, whereas only 0.1% of all cases have appendicitis present in an inguinal hernia. case report: A 40-year-old male presented to emergency department with incarcerated left inguinal hernia and pain over the hernia since two days. Abdominal examination was normal except for tenderness and increased temperature over the left inguinal hernia. through an inguinoscrotal incision opening of sac revealed pus and flakes with perforated appendix. Lower midline laparotomy incision was given and found the tip of perforated appendix to lie at the left deep inguinal ring. Appendicectomy with pelvic toileting was done. bassini repair was done in the inguinal region. conclusion: to conclude left sided Amyand’s hernia is very rare. High index of suspicion is required for diagnosis and this should be kept as a differential diagnosis for such a varied presentation.

Prenatal ultrasound diagnosis of a fetal testis granulosa cell tumour

Normally, by the 5th month of pregnancy, the fetal testes lie close to the deep inguinal ring and begin to descend to the scrotum during the 7th month. The testicles should be found in the scrotal ...

Do Infants and Children have Measurable Inguinal Canals?

Introduction: Herniotomy is a common procedure performed by Paediatric Surgeons. However, opinions differ as to whether to open the inguinal canal when performing this procedure or not. Those who advocate performing herniotomy without opening the inguinal canal believe that in early childhood, the superficial inguinal ring is directly superimposed on the deep inguinal ring, there being no appreciable inguinal canal in this age group. Our study was planned to open the inguinal canal and simply measure the distance between the pubic tubercle medially and the inferior epigastric vessels laterally. Finding a measurable inguinal canal in all cases studies debunks the belief that the superficial inguinal ring frequently overlaps the deep inguinal ring. Materials and Methods: From October 2007 to September 2008 and from May 2012 to April 2013 the inguinal canals of 75 children from 1 day to 2 years old were measured during herniotomies and orchidopexies. Premature babies were excluded from this study. The inguinal canals were all opened. Using a simple sterilized metallic ruler, the distance between the ipsilateral inferior epigastric vessels and the ipsilateral pubic tubercle was measured. Results: The lengths of the inguinal canals ranged from 1cm to 4.5 cm (mean 2.88cm+/-.71cm SD). The shortest inguinal canal length was 1 cm while the longest inguinal canal was 4.5 cm. Conclusion: Children with inguinal hernia up to the age of 2 years have a measurable inguinal canal and we suggest the excision of the hearnial sac superficial to the external inguinal ring runs the risk of leaving substantial sac behind proximal to the transfixing suture, even when some traction is applied to the sac before applying the transfixing suture. DOI: http://dx.doi.org/10.3126/jnps.v33i3.8355 J. Nepal Paediatr. Soc. 2013;33(3):182-185

English

BACKGROUND: Meshplasty for hernia repair is a must in adult patient. Prolene mesh is widely used and is fixed with prolene suture as well.The aim of this study was to compare the quality of life and pain felt in postoperative phase for 2 years after open inguinal hernia repair by interrupted sutures versus continuous sutures. METHODS: From Jan 2010 - Dec 2010, 15 patients were operated for hernia using prolene mesh and this mesh was fixed with prolene 2'0' in continuous waystarting at pubic tubercle and continued along inguinal ligament beyond deep inguinal ring, then lateral to deep inguinal ring, aboveit along conjoint tendon andending at the pubic tuberclewith only single knot. This type of repair was compared with 15 patients who underwent same procedure using prolene mesh fixed with prolene suture but in interrupted waywhich creates alot of knots (10-12Average).Patients were examined and followed up in OPD for 2 years. RESULTS: In the long run the patients treated with continuous suture had comparatively better quality of life with less pain and less foreign body sensation of mesh and knots & knots were not felt percutaneously,where as in routine procedure patients complained of painful sensation due to pressing of knots in subcutaneous space. CONCLUSION: In this study the quality of life in open hernia repair with prolene suture using continous suture technique versus interrupted suture technique is definitely better, less painful with feeling of less foreign body sensation.

English

Abstract Introduction Testicular vessels play a major role in thermoregulation of male reproductive organs, which is an essential aspect for their effective functioning. Testicular veins exhibit wide variations in their course, number and mode of termination. Case report A variation in the testicular vein was observed unilaterally in a 50year-old male cadaver during the course of a preclinical training program. Two testicular veins (medial and lateral) were present on the left side. Both medial and lateral testicular veins were found draining into the left renal vein at right angles. The lateral testicular vein displayed bifurcation close to its termination into the left renal vein. The right testicular vein followed usual course and drainage. The left kidney also exhibited a distinct intrarenal cleft. Conclusion The testicular vein variations become significant during ligation of the abnormal venous dilatations and collaterals, thereby reducing the chances of recurrence of varicocele which is a specific pathological condition causing male infertility. The present case report attempts to provide an insight into the developmental aspects and surgical importance of this unusual variation. Introduction Testicular veins are the channels arising from the pampiniform plexus of veins which is formed at the upper pole of the testis by the smaller veins draining the testis. It then traverses through the spermatic cord and at the superficial inguinal ring, four veins are formed which course through the inguinal canal and at the deep inguinal ring, these coalesce and form two or three veins. In the lumbar region, these veins combine and form a single testicular vein on the respective sides. These testicular veins ascend along the posterior abdominal wall anterior to the psoas major muscle, ureter and behind peritoneum. The right testicular vein drains into the inferior vena cava (IVC) at an acute angle, whereas the left testicular vein drains into the left renal vein at right angles1. The anatomy of testicular veins has been associated with wide variations. These variations become significant during clinical cases of varicoceles and retroperitoneal surgeries. Varicocele affecting approximately 15% of the male population is the abnormal dilatation of veins of pampiniform plexus causing testicular atrophy and male infertility2,3.

The inguinal and femoral canals: A practical step-by-step approach to accurate sonographic assessment

Ultrasonography (USG) is an accepted and reliable tool for the assessment of groin hernias. However, USG of the groin is operator dependent and challenging. The anatomy of this region is complex and the normal sonographic findings can be difficult to interpret. We describe the relevant normal anatomy of the groin relating to inguinal and femoral hernias, and describe a straightforward, reliable technique for identifying and assessing the integrity of the inguinal and femoral canals. The inferior epigastric vessels are a critical landmark for assessment of the inguinal canal and deep inguinal ring.

Left Amyand's hernia in children: Method, management and myth

The presence of the appendix within an inguinal hernia is referred to as Amyand's hernia.1 A paediatric surgeon can expect to discover the appendix in one of every 1000 hernia sacs,2 usually at emergency herniotomy. We report an even rarer presentation – left-sided Amyand's hernia discovered unexpectedly at elective surgery in a baby and a toddler. Elective bilateral inguinal herniotomies were performed on a 10-week-old twin boy who had been born at 27 week's gestation. Both hernias were reducible since detection on day 9 of life. The left hernia sac contained small bowel, caecum and appendix. The contents were easily reduced in to the abdomen, and routine inguinal herniotomy was performed. Recovery was uncomplicated. A 13-month-old boy was followed up in clinic having presented at 5 weeks of age with a right communicating hydrocele. The right hydrocoele had resolved, but there was now a reducible right inguinal hernia. He had also developed a tense, non-tender, irreducible left inguino-scrotal swelling thought to be a hydrocoele. A right inguinal herniotomy was subsequently performed in the standard manner. On opening the left inguinal canal to repair the hydrocoele, the inguino-scrotal swelling was actually found to be an incarcerated inguinal hernia. The hernia comprised terminal ileum, caecum and appendix. The bowel was viable and, after further proximal extension of the incision in the peritoneum, was easily reduced in to the abdomen without appendicectomy. The hernia sac was transected distally, preserving the vas and testicular vessels as per routine inguinal herniotomy. Proximally, the edges of the peritoneum were closed with a continuous absorbable suture. An upper gastro-intestinal (GI) contrast study showed normal rotation of the gut. Amyand had a big day on December 6th 1735 at St. George's Hospital, London. Not only did he perform the first appendicectomy, he described finding the appendix, perforated by a pin, in a right inguinal hernia of an 11-year-old boy.3 To unexpectedly find a left Amyand's hernia in two children at elective operation is most unusual. The majority of reported cases of left Amyand's hernia present as emergencies, appendicitis or strangulated hernia, in adults. The largest series of Amyand's hernia in children reports on 30 cases, only three of which were left sided.4 One of the three presented with perforated appendicitis in the hernia, and the other two were detected on axial imaging pre-operatively. We describe the technique of herniotomy in this unusual situation for the first time. By carefully incising the encasing processus vaginalis and extending this incision distally on the spermatic cord and proximally towards the deep inguinal ring, enough exposure was possible to: (i) identify the hernia contents; (ii) inspect the hernia contents for viability; (iii) reduce the hernia to the abdominal cavity; and (iv) repair the hernia by herniotomy. All reports to date suggest that the caecum and appendix herniate through the left inguinal canal because of either high caecal mobility, situs inversus or malrotation of the gut. In one case report, the finding of an appendicitis in the left inguinal canal lead the surgeons to consider malrotation, and a midline laparotomy was performed simultaneously5 – the bowel was rotated normally. Our second patient underwent a post-operative upper GI contrast study which was normal. In the absence of any report of left Amyand's hernia in children or adults associated with situs inversus or malrotation, we suggest that these concerns are unfounded, and certainly, exploratory laparotomy can be avoided. It is generally agreed in all preceding case reports that appendicectomy in Amyand's hernia is not indicated unless it is inflamed or strangulated. However, Johari et al.6 suggest removing a normal appendix when found in the left inguinal canal as this raises the possibility of malrotation and the potential for later atypical presentation with appendicitis. Again, the current authors believe that in the absence of inflammation and any report of associated malrotation with left Amyand's hernia, ‘prophylactic’ appendicectomy is not indicated. Our rare cases allowed us to describe in detail the operative management of left Amyand's hernia in children discovered at elective operation. Rather than repeating old myths, we have outlined the management of these children, specifically advising against prophylactic appendicectomy of a non-inflamed appendix, and the avoidance of unnecessary interventions (laparotomy) or investigations (contrast studies) for malrotation or situs inversus.

Congenital cryptorchidism - its anatomical aspects, embryogenesis and clinical consequences

The testes are a pair of male reproductive organs. The testicular variations are unusual and can result in multiple clinical conditions. Congenital cryptorchidism is a condition in which one or both the testes have not passed down the scrotal sac. During a routine cadaveric dissection of a middle aged male cadaver, in the left side of the pelvic part of the abdomen an unusual undescended testis was noted near the deep inguinal ring. Additional to this we also noted a thick band of ligament connecting the epididymis of testis to the fascia transversalis, close to the deep inguinal ring. As per our knowledge such congenital testicular variations has not been cited in the recent medical literature. The anatomical aspects, embryogenesis and clinical consequences of these congenital variations have been discussed in detail. Proper knowledge and awareness of such testicular variations is clinically essential in operative procedures and necessary treatment for monarchism, which improves fertility and endocrine functions.

Diagnostic Laparoscopy Through Deep Inguinal Ring

To systematically review the published literature on the role of diagnostic laparoscopy through deep inguinal ring (DL-DR) during groin hernia repair. Standard electronic databases were searched reporting article in any language on the role of DL-DR during groin hernia repair regardless of the age and sex of patients. Thirty-one articles on 5745 patients undergoing DL-DR during groin hernia repair were retrieved from the electronic databases. There was 1 randomized, controlled trial, 7 case reports and 2 case series on 58 adult patients mainly targeting assessment of bowel viability following spontaneous reduction of the strangulated groin hernia. Twenty-one articles, either retrospective or prospective case series on 5687 were reported on pediatric patients aiming to detect a contralateral patent processus vaginalis or synchronous groin hernia. Overall, the laparoscopy group had a reduced operative time, reduced length of hospital stay, lower complication rate, and earlier return to normal activity. DL-DR success rates were reported in >95% of patients. Contralateral patent processus vaginalis indicative of inguinal hernia was found in >48% of children. There was no major morbidity reported in any group. DL-DR during groin hernia repair may be performed safely when indicated. The routine use of DL-DR is an established practice in pediatric surgery. There is still insufficient evidence to recommend the routine use of DL-DR in adults.

Minimal incision transinguinal repair for incarcerated obturator hernia

Patients with incarcerated obturator hernia are usually elderly, frail, and physically inactive women with serious comorbidities. Although a laparotomy is standard surgical intervention for emergency incarcerated or strangulated obturator hernia, it is invasive particularly for these high-risk patients. The aim of this study is to show the feasibility of minimum open inguinal approach to reduce surgical risk for preoperatively diagnosed incarcerated obturator hernia. Between April 2008 and July 2012, 3 consecutive incarcerated obturator hernia patients at Kamitsuga General Hospital who were diagnosed preoperatively by computed tomography underwent the following procedure. First a 4 cm inguinal hernia incision and preperitoneal dissection through the opening of the deep inguinal ring are made. The obturator hernia can be easily found 2 cm dorsally from the Cooper's ligament extraperitoneally. A small incision is made at medial sharp edge of the hernia defect. The hernia sac and its content can then be reduced. If the incarcerated bowel is viable, a prosthetic mesh is placed as a patch. If the bowel is necrotic, the damaged bowel loop is withdrawn through the wound and easily reconstructed extra-abdominally. All operations were successfully completed with this procedure. All patients recovered without incident. Minimal incision transinguinal repair for diagnosed incarcerated obturator hernia is feasible and provides an improved option to more invasive procedures.

Retroperitoneal hematoma after manual reduction of indirect inguinal hernia

This report presents the case of a 59-year-old man with sudden severe pain in the right lower abdomen after manually reducing the right indirect inguinal hernia who had bilateral indirect inguinal hernia for 5 years. A subsequent contrast computed tomography scan with contrast of the abdomen and pelvis revealed a significant extensive retroperitoneal hematoma at the abdomen and pelvis of the right side. There was contrast leaked out, which was suspected from inferior epigastric artery. He underwent successful laparotomy. The bleeding ruptured inferior epigastric artery at the interior side of the deep inguinal ring was found, the deep inguinal ring was avulsed, ligature of the inferior epigastric artery and removal of the retroperitoneal hematoma were done, and the patient was discharged from hospital on the seventh postoperative day. This is the first report in the literature on retroperitoneal hematoma caused by manual reduction of indirect inguinal hernia.

Müllerian anomaly with ovary at deep inguinal ring: A rare case finding

Müllerian anomaly with ovary at deep inguinal ring: A rare case finding

Totally Laparoscopic Repair of an Acutely Inflammed Amyand’s Hernia

Introduction: Amyand’s hernia – the presence of appendix within an inguinal hernia sac poses a diagnostic and therapeutic challenge in the acute setting. Case Presentation: We report the case of a female patient on long-term corticosteroid therapy that was found at laparoscopy to have an inflamed appendix incarcerated within a right inguinal hernia. A 62-year-old Caucasian female presented with a short history of suddenonset pain in the right groin. Her past medical history included polymyalgia rheumatic for which she had been treated over the past 4 years with oral prednisolone. The studied case was successfully treated through laparoscopic appendectomy and laparoscopic suturing of the deep inguinal ring. Discussion: This totally laparoscopic approach may be of use in cases where definitive treatment with mesh cannot be undertaken and the avoidance of large wounds is desirable.

Standardization of laparoscopic pelvic examination

To propose a novel standardized and reproducible system to be used for reporting positive and negative findings during diagnostic and operative laparoscopy based on anatomical landmarks. Video presentation of clinical article. The video uses animation and surgical cases to demonstrate a systematic examination of the female pelvis based on anatomical landmarks to establish a standardized way of reporting. Tertiary care referral center. Not applicable. Not applicable. Not applicable. This video demonstrates a proposal to standardize laparoscopic pelvic examinations. The pelvis is topographically divided into two midline zones (zone I and II) and two paired (right and left) lateral zones (zone III and IV). Zone I is the area between the two round ligaments from their origin at the uterine cornua to their insertion in the deep inguinal rings. Zone II is the area between the two uterosacral ligaments from their origin from the back of the uterus to their insertions in the sacrum posteriorly. Zone III is the area between the uterosacral ligament inferiorly and the entire length of the fallopian tube and the infundibulo pelvic ligament superiorly. Zone III contains the tubes and the ovaries. Zone IV is the triangular area lateral to the fallopian tube and the infundibulo pelvic ligament and medial to the external iliac vessels up to the round ligament. This system is based on standardized anatomical landmarks. It is user friendly, reproducible and allows systemic search of the pelvis to document the presence or absence of any pathology. It could improve diagnostic accuracy, help diagnose lesions in anatomically challenging locations, and provide the required standardization with its clinical and academic advantages. Video is available at http://fertstertforum.com/bedaiwym-standardization-laparoscopic-pelvic-examination/.