Pelvic Sidewall Anatomy in Gynecologic Oncology-New Insights into a Potential Avascular Space

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.

Automated summary

Except for early-stage tumors and fertility preservation, the surgical treatment of gynecological malignancies is not limited to the affected organ. Dissecting tissues in the region of metastatic iliac lymph nodes or gynecological tumors near the pelvic sidewall is necessary. In addition, surgeries for deep infiltrating endometriosis or oncological procedures often require dissection of the pelvic sidewall. Precise dissection and detailed anatomical knowledge are crucial. Terminology regarding the pelvic sidewall is controversial, and this study aims to define a new term and boundaries of a potential avascular space, the medial psoas space, for surgical guidance.