Surgical anatomy of the pectineal ligament during pectopexy surgery: The relevance to the major vascular structures

Objective: During pectopexy surgery, the prolapsed uterus or the vaginal apex is fixed to the pectineal ligament. The anatomic structures found in the lateral part of the prevesical and paravaginal space above the obturator fossa, raise the importance of the surgical steps required to prevent complications. This study was conducted to evaluate the proximity of vascular structures to the pectineal ligament. Materials and Methods: The distances between the surgical suturing area during pectopexy surgery and the external iliac vein, pubic anastomotic vessel (corona mortis) and obturator canal were measured bilaterally in seven fresh female cadavers. Results: The total length of the pectineal ligament was 5.9+/-0.76 cm on the left and 6.5+/-1.14 cm on the right side; the midpoint of the pectineal ligament was 2.8+/-0.52 cm on the left and 3.6+/-0.47 cm on the right side. From the midpoint of the left pectineal ligament, the mean distance to the left external iliac vein was 1.04+/-0.23 cm, to the left corona mortis it was 2.15+/-0.48 cm, and to the left obturator canal it was 3.12+/-0.95 cm. From the midpoint of the right pectineal ligament, the mean distance to the right external iliac vein was 1.25+/-0.43 cm, to the right corona mortis it was 2.37+/-0.63 cm, and to the right obturator canal it was 3.57+/-0.93 cm. Conclusion: The anatomic findings of the study confirmed that the pectineal ligament was in close association with main vessels. The external iliac vein was measured as the closest anatomic structure to the pectineal ligament. Surgeons must be careful to minimize life-threatening complications because of the proximity of the pectineal ligament to main vessels.