Variability of the origin of the uterine artery: Laparoscopic surgical observation

Authors


Dr Zdenek Holub, Chairman of Obstetrics and Gynecology, Endoscopic Training Center, Baby Friendly Hospital, Vancurova 1548, 272 58 Kladno, Czech Republic. Email: holubz@seznam.cz

Abstract

Aim: To categorize the surgical anatomic variants of the origins of the uterine arteries and to clarify the difference in the description of the internal iliac artery in the contemporary anthropologic, radiologic and surgical system.

Methods: One hundred women with symptomatic fibroids were treated using retroperitoneal laparoscopic dissection of the uterine vessels (LDUV). Retrospective evaluation of the operative records and videos was carried out. The anatomical classification of Adachi (type I–V) was modified for surgical purposes (type I–IV).

Results: Laparoscopic retroperitoneal dissection and LDUV were carried out successfully using an ultrasonic operative technique in all women. The branching of the branches of the internal iliac artery was studied on the right side of the pelvis. Of the 100 uterine arteries that were evaluated, 81% were classifiable types and 19% of surgical dissections were inconclusive. Classification was as follows: type I, 30.8%; type II, 23.4%; type III, 45.6%; and type IV was not found. Modified surgical classification type III (visceral branches arising from the umbilical artery and the internal pudendal artery) was claimed to be statistically the most common type.

Conclusion: Laparoscopic dissection of the uterine artery close to the origin of the uterine artery can be carried out safely in the most frequent types of surgical classification. The meticulous dissection of the uterine artery in cases in which the uterine artery does not arise typically from an unobliterated segment of the internal iliac artery was recommended.

Ancillary