Table 1.
Avascular spaces—applications and attention during dissection.
| Avascular Spaces | Application of Avascular Spaces | Attention during Dissection | ||
|---|---|---|---|---|
| Oncogynecology/Gynecology | Urogynecology | Obstetrics | ||
| LPS | Pelvic lymphadenectomy, RH, RVH, SLNB | Burch colposuspension, paravaginal repair | Cesarean hysterectomy, LA/A cerclage | CORM |
| MPS | Anterior exenteration, RH, DE treatment, RVH, SLNB | Ureteric reanastomosis, paravaginal repair | Cesarean hysterectomy, LA/A cerclage | CORM |
| Latzko’s’ space | Pelvic lymphadenectomy, RH, uterine artery ligation, nerve-sparing procedures, RVH, sentinel lymph node biopsy, SLNB | Ureter surgery for DIE or GC | Internal iliac artery ligation | Lateral sacral/hemorrhoidal vessels, pelvic splanchnic nerves |
| Okabayashi’s space | Nerve-sparing procedures, RH, LUNA procedure, bowel resection for DIE or GC, RVH, SLNB | Ureter surgery for DIE or GC | Middle rectal vessels, PP, hypogastric nerves | |
| Fourth space | Nerve-sparing procedures during DIE or GC | Ureter surgery for DIE or GC | Vesico-uterine ligament vessels | |
| Retropubic space | Anterior exenteration, pelvic anterior peritonectomy, bladder endometriosis | MESH removals, ureteric re- implantation, retropubic TVT, anterior vaginal compartment repairs, Burch colposuspension, MMK procedure | Veins of Santorini, Dorsal vein of clitoris | |
| VU/VV space | TLH, RH, RVH, nerve-sparing procedures, management of DIE, vaginal cuff resection | Vesico- uterine/vaginal fistula repair, bladder/ureter endometriosis, transvaginal cystocele operations, sacrocolpopexy | CS, Cesarean hysterectomy, LA/A cerclage, CS scar ectopic excision | uterine artery, superficial uterine vein, ureter branch of the uterine artery, superior vesical vein, cervicovesical vessels |
| Rectovaginal space | RH, rectovaginal fistula repair, treatment of pelvic adhesions, bowel resection for DIE | Sacrocolpopexy, uterosacral ligament suspension, | Vaginal, presacral veins, middle rectal vessels | |
| Presacral space | bowel resection for DIE, presacral neurectomy, TME for GC, initiation of para-aortic lymphadenectomy | Sacrocolpopexy, hysterocolpopexy, | Common iliac, middle sacral vessels, inferior mesenteric artery, ureters, superior hypogastric plexus, hypogastric nerves | |
LPS—lateral paravesical space; MPS—medial paravesical space; VU/VV—vesicouterine/vesicovaginal; RH—radical hysterectomy; RVH—radical vaginal hysterectomy; DE—deep endometriosis; TLH—total laparoscopic hysterectomy, TME—total mesorectal excision; CS—cesarean section; GC—gynecological cancer; LA/A—laparoscopic/abdominal; CORM—corona mortis; MMK—Marshall–Marchetti–Krantz procedure; SLNB—sentinel lymph node biopsy.