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Abstract
Introduction/Background The dissection of the presacral region is an integral component of multiple gynecologic cancer procedures such lymph node staging, advanced staged disease and recurrence surgeries. The lack of knowledge of the anatomy can lead to severe complications such as vascular, ureteral, or nerve injuries that make up the complex region. To show anatomic concerns when surgeons dissect this region and to avoid severe complications we have developed a cadaveric video of the presacral region as well as the analysis and disposition of the more important anatomical landmarks.
Methodology We hereby demonstrate the anatomic data concerning the presacral region. Fifteen female cadaveric dissection models were evaluated. The presacral space was dissected to clearly defined anatomic landmarks. The midline of the region was marked from the promontory to its inferior edge, and measurements were taken from this imaginary line to key anatomical structures proximal to the presacral space. Special emphasis is placed on guiding the surgeon using still photographs and videos of cadaveric and live tissue dissection to optimize the understanding anatomy of the region.
Results The disposition of the following structures was analyzed in relation to the midline of the region; right ureter, right iliac vessels, left iliac vessels, specially left common iliac vein and hypogastric plexus. Additionally, middle sacral vessels were studied. The average distance between the midline of the region and right ureter was 3.1 cm, right common iliac vein 1.9 cm, right common iliac artery 2.6 cm, left common iliac vein 2.7 cm and left common iliac artery 3.4 cm. The location of the middle sacral vessels was quite variable
Conclusion We highlight in this video the identification and systematization of the most important anatomical structures and landmarks located in the presacral region with the aim of achieving a safe dissection during gynecologic cancer procedures.