The ligamentary attachments of the female genital organs add to selleck kinase inhibitor the anatomical uniqueness of the pelvis. For instance, the round ligament, which extends from the cornua to the internal ring, could harbor pathology from its origin to its insertion. The uterosacral ligaments and the suspensory ligaments of the ovary are often inspected but not described. Other anatomically obscure locations include the ovarian fossa, the lateral pelvic sidewall, and the area inferior to the uterosacral ligament. The objective of this study is to propose a method for systematic pelvic assessment based on anatomical landmarks and structured documentation with laparoscopic photography. To illustrate the current deficiencies, we retrospectively applied this system to a cohort of patients who underwent laparoscopy for unexplained infertility to assess the comprehensiveness of the operative reports.
2. Materials and Methods 2.1. Proposed System In our proposed system, the pelvis was topographically divided into two midline zones (zone I & II) and two paired (right and left) lateral zones (zone III & IV). Zone I is the area between the two round ligaments from their origin at the uterine cornua to their insertion in the deep inguinal rings. Zone II is the area between the two uterosacral ligaments from their origin from the back of the uterus to their insertions in the sacrum posteriorly. Zone III is the area between the uterosacral ligament inferiorly and the entire length of the fallopian tube and the infundibulopelvic ligament superiorly.
Zone IV is the triangular area lateral to the fallopian tube and the infundibulopelvic ligament and medial to the external iliac vessels up to the round ligament (Figure 1). The contents of the different zones are shown in Table 1. Figure 1 A color-coded illustration of the anatomical boundaries and the contents of all pelvic zones. Table 1 Descriptive summary of the anatomical boundaries and the contents of each pelvic zone. 2.2. Retrospective Evaluation of Dictated Reports This study was conducted at the University Hospitals Case Medical Center (UHCMC), Case Western Reserve University, Cleveland, Oh, USA. After IRB approval was obtained, operative reports of 540 patients who underwent diagnostic or operative laparoscopy for the diagnosis of unexplained infertility between January 2005 and January 2012 were collected.
The operative reports for these patients were reviewed GSK-3 with allocation of the reported positive or negative findings to the respective zones as shown above. All reports were evaluated for the comprehensiveness of the description with respect to normal findings or pathology for six zones as follows. Using this mapping of the pelvis, the operative reports were reviewed for completeness in description of anatomical findings. Descriptive statistics are presented. 3.