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Toronto Notes 2019 Basic Anatomy Review
• infundibulopelvicligament:continuoustissuethatconnectsovarytopelvicwall
■ contains the ovarian artery, ovarian vein, ovarian plexus, and lymphatic vessels
Gynecology GY3
• positionoftheuterus
■ anteverted (majority), retroverted, neutral
Round ligament Fallopian tube
Ovary
Broad ligament
Ligament
of the ovary
Uterus
Suspensory ligament of ovary
(infundibulopelvic ligament)
Posterior view
1
2
3
Anterior view
Figure 2. Genital organs and positioning of the uterus
D . FALLOPIAN TUBES
Cardinal ligament Uterosacral ligament
© Desmond Ballance 2006
1. Anteverted anteflexed 2. Retroverted retroflexed 3. Retroverted anteflexed
©Kateryna Procunier 2016 after Marina Chang 2013
Determination of uterine position by clinical exam
• If cervix faces anteriorly (under the urethra
and less easily accessible), i.e. toward vaginal orifice, more likely RETROVERTED UTERUS
• If cervix faces posteriorly (easily accessible), i.e. toward sacrum or rectum, more likely ANTEVERTED UTERUS
• If uterus palpable on bimanual exam, more likely ANTEVERTED UTERUS
“Water Under the Bridge”
The ureters run posterior to the uterine arteries
Common Anatomy Questions in the OR
• What is the origin of the left and right ovarian arteries?
Descending aorta
• What are the drainage sites for the left and right ovarian veins?
Left to left renal vein, right to inferior vena cava
• What is the most common place to locate the ureter?
Pelvic brim, medial leaf of the broad ligament as it passes under the uterine artery
• Which artery runs under the round ligament?
Sampson’s artery
• 8-14cmmusculartubesextendinglaterallyfromtheuterustotheovary
• interstitial,isthmic,ampullary,andinfundibularsegments;terminatesatfimbriae • mesosalpinx:peritonealfoldthatattachesfallopiantubetobroadligament
• bloodsupply:uterineandovarianarteries
E . OVARIES
• consistofcortexwithovaandmedullawithbloodsupply
• supportedbyinfundibulopelvicligament(suspensoryligamentofovary)
• mesovarium:peritonealfoldthatattachesovarytobroadligament
• bloodsupply:ovarianarteries(branchesoffofaorta),leftovarianvein(drainsintoleftrenalvein),right
ovarian vein (drains into inferior vena cava)
Abdominal aorta Ureter
Ovarian artery
Internal iliac artery External iliac artery
Ovarian and tubal branches of uterine artery
Sampson’s artery (within round ligament)
Uterine artery
Vaginal artery
External pudendal artery
Figure 3. Vascular supply
© Krista Shapton 2010