The document discusses the retroperitoneum and provides some key details: - The retroperitoneum refers to all organs, vessels, nerves, tissues and connective fascia on the posterior abdominal wall and contiguous pelvic structures. - The retroperitoneum has a convoluted anterior border that extends into spaces between the intestines. - The document then discusses a demonstration involving 7 surgical cases to highlight relevant anatomical considerations for different procedures in the retroperitoneal space. Each case will recap the relevant anatomy and surgical extent. - The goal is to provide perspective on surgical extent and disease/management specifics, but general pathology or protocols will not be discussed. Topography and specific anatomical structures will be

2. Retroperitonium

3. Retroperitoneum
‘‘The retroperitoneum is an uncharted sea... the
retroperitoneal spaces are vast territories lacking an
accurate and accepted map.’’ Skandalakis et al.
All organs, vessels, and nerves that lie on the posterior
abdominal wall, along with their tissues and surrounding
connective and fascial planes, are collectively referred to as
the retroperitoneum contiguous with the extraperitoneal
pelvic structures caudally
Although technically bounded anteriorly by the posterior
reflection of the peritoneum, the anterior border of the
retroperitoneum is quite convoluted, extending into the
spaces in between the mesenteries of the small and large
intestines.

4. Demonstration
• Case based anatomical considerations
• Less extensive to more extensive cases
• Recapitulation with every case
• Gives perspective to surgical extent
along with anatomy
What to expect ?
• Disease specific pathology or
management protocol discussion
What not to expect ?

5. Demonstration
Team
Dr Ajay Halder
Dr Sunita Athavale
Dr Shweta Patel
Dr Samidha – Case Presentation
Dr Gargi – Camera
Ms Mittal Mewada – Nursing Assistant

6. Topography

7. Case-1
27 years P2L2 with previous 2 LSCS with morbidly
adherent placenta.
Plan- Prophylactic IIA ligation
Anatomical consideration: Internal Iliac artery and
ureter identification

8. Case-2
56 years P2L2 with Post menopausal bleeding.
Histopathology Examination of Endometrial biopsy shows Endometrial
Intraepithelial Neoplasia
Plan- Total Laparoscopic Hysterectomy
Anatomical considerations: Ligation of Uterine Artery at origin and
development of Vasico vaginal Space

9. Case-3
32 years women with chronic pelvic pain and primary
amenorrhea. Previously had laproscopyc bilateral ovarian
cysytectomy and adhesiolysis for endometriosis.
Plan- Laparotomy and proceed due to recurrence of bilateral
ovarian endometriosis with severe pain
Anatomical considerations- pararectal space and ureterolysis

10. Case-4
56 years P2L2 with Post Menopausal Bleeding. Histopathology of
Endometrial Biopsy shows Adenocarcinoma Gr 3 confined to uterine
corpus less than 50 % myometrial involvement in MRI
Planned for Simple Hysterectomy B/L Pelvic lymphadenectomy
Anatomical considerations: Lateral Pararectal, Para Vesical Spaces
with boundaries of Pelvic lymphadenectomy

11. Case-5
60 years P4L4 with PMB and PCB. P/S shows 3 cm growth on anterior
cervix. HPE Poorly Differentiated SCC
MRI shows 3.5 cm mass confined to cervix . Vagina and Parametrium
are free
Plan: Type C hysterectomy with B/L PLND
Anatomical considerations: medial pararectal space (okabayashi,
medial paravaginal space. Ureteric tunnel

12. Case-6
44 years P2L2 complaining of SUI not controlled by
conservative methods.
Planned for Burch colpo-suspention
Anatomical considerations: Space of retzius-white
line-iliopectineal ligament

13. Case-7
58 years P2L2 post Vaginal Hysterectomy for prolapse has
developed total eversion of vagina.
Plan – Sacro-colpopexy
Anatomical considerations: Retro rectal space, rectovaginal
space, Vesicovaginal space

14. Para-Aortic dissection
(Station- D)