Procedures + Anatomy

Question 1

Course of ureter

Answer 1

25cm, kidney to bladder

Leaves kidney, retroperitoneal
Along psoas muscle
At level SI joint, enters pelvis
Goes lateral to medial, over common iliac bifurcation
Through broad ligament, ureteric fold
Goes UNDER uterine artery
Anteromedially to pierce bladder posteriorly

Question 2

Sacrospinous fixation

Answer 2

LA rectovaginal space
Posterior mucosa incision
Pararectal space entered
Rectum mobilised via sweeping from lateral to medial
Sacrospinous ligament palpated
Using 0 prolene + capio needle, place suture through ligament 2cm medical to ischial spine
Anchor to vaginal vault using Mayo needle

Question 3

TAH

Answer 3

Midline or pfannenstiel incision
Down to peritoneal cavity
Identify round, ligate and divide
Enter broad ligament, visualise ureter, ensure well down
Anterior peritoneum, gently reflected exposing UV fold
Take ovarian pedicle/IP depending on if BSO
Uterines idefntified, clamped and cut
Cardinal ligaments clamped and cut
Vault opened, clamps on cervico-vginal junction
Uterus removed
Angles secured with vicryl, incorporating uterosacrals for support
Vault closed with vicryl
Ureters checked
Pelvis irrigated
All pedicles checked

Question 4

Krukenburg tumour

Answer 4

Ovarian met

Usually GI primary