Standardization of laparoscopic pelvic examination

Capsule:
Standardization of laparoscopic pelvic examination will make lesions in anatomically challenging locations less likely to miss.

Authors:
Mohamed A. Bedaiwy, M.D., Ph.D., Drisana Henry, M.S., James Liu, M.D., Tommaso Falcone, M.D.

Volume 99, Issue 5, Pages e11, April 2013

Abstract:

Objective:
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.

Design:
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 or reporting.

Setting:
Tertiary care referral center.

Patients:
Not applicable.

Main Outcome Measures:
Not applicable.

Results:
This video demonstrates a proposal to standardize laparoscopic pelvic examination. The pelvis is topographically divided into 2 midline zones (zone I&II) and 2 paired (right andleft) lateral zones (zone III&IV). Zone I is the area between the 2 round ligaments from their origin at theuterine cornua to their insertion in the deep inguinal rings. Zone II is the area between the 2 uterosacralligaments from their origin from the back of the uterus to their insertions in the sacrum posteriorly. Zone IIIis the area between the uterosacral ligament inferiorly and the entire length of the fallopian tube and theinfundibulopelvic ligament superiorly. Zone III contains the tubes and the ovaries. Zone IV is the triangulararea lateral to the fallopian tube and the infundibulopelvic ligament and medial to the external iliac vesselsup to the round ligament.

Conclusions:
This system is based on standardized anatomical landmarks. It is user friendly, reproducibleand allows systemic search of the pelvis to document the presence or absence of any pathology. It couldimprove the diagnostic accuracy, help diagnose lesions in anatomically challenging locations and provide therequired standardization with its clinical and academic advantages.

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