Click Here for Disclosure Information
 

Following the principles taught in the International School of Surgical Anatomy-(ISSA), this hands-on cadaveric course will provide a step-by-step surgical approach to the pelvic viscera, retroperitoneal avascular spaces and pelvic ureters.  Emphasis will be put upon identifying anatomical landmarks, including surgical principles and techniques to enter the retroperitoneal avascular spaces. Instruction on techniques for gentle tissue handling to avoid bleeding, proper traction, counter-traction, sharp and blunt dissections while preventing vascular, urinary, bowel and nervous complications. Special care will be given to nerve-sparing techniques during laparoscopic dissection, with demonstration of main pathways of visceral and somatic pelvic innervation. This course includes cadaveric specimen with intact uteri and cervix using laparoscopic instrumentation.  

Learning Objectives: At the end of this course, the participant will be able to: 1) Recognize the anatomical landmarks and major pelvic structures pertinent to gynecologic laparoscopy and retroperitoneal dissection; 2) Apply laparoscopic surgical techniques to enter and expose the avascular spaces of the pelvis, parametrial ligaments, nerves and pelvic vasculature and their relations to the ureter and intraperitoneal structures; and 3) Illustrate the step-by step dissection of the pelvic ureter and pelvic-nerves related to the different gynecological procedures and nerve-sparing techniques for gynecologic cancers and endometriosis surgery.

Course Outline:
LAB I: Hands-on Laparoscopic Dissection of Uterus, Adnexa, Parametrial Ligaments and Lateral Pelvic Sidewall: Tips and Tricks to Perform Safe Laparoscopic Hysterectomy and Adnexal Surgery: Opening of para-vesical and para-rectal spaces, dissection and isolation of the ureter, pelvic vessels and uterine artery hypogastric artery identification and ligation, identification and resection of the cardinal ligament opening retropubic space of Retzius, identifying bladder pillars and anterior parametrium, isolation of the ureter in the ureteral tunnel tips and tricks for performing safe radical hysterectomy, pelvic lymphadenectomy, and managing complications

LAB II: Hands-on Laparoscopic Dissection of Posterior Compartment and Pelvic Nerves:
Dissection of pre-sacral, retro-rectal, ileo-lumbar and recto-vaginal spaces
Identification and isolation of visceral pelvic innervation: inferior mesenteric plexus, superior hypogastric plexus, hypogastric nerves, pelvic splanchnic nerves, pelvic plexus
Tips-and tricks for nerve-sparing pelvic surgery in gynecologic oncology and deep endometriosis procedure
Identification of obturator nerve, sciatic nerve, pudendal nerve, sacral plexus, sacral roots, avoiding and managing complications.