Uterus and Ligaments of Support

Identification of normal anatomy, as well as anatomy that has pathology, is essential in order to safely perform pelvic laparoscopic, robotic-assisted, and hysteroscopic surgery. The essentials of performing laparoscopic and hysteroscopic surgery include a comprehensive understanding and familiarity with the surgical anatomy of the uterus, adnexa, ligaments of support and nearby major blood vessels. Unlike with conventional laparotomy, haptics and spatial orientation can be a source of limitation when identifying these structures and performing these surgeries. Using a uterine manipulator can help position the uterus to better identify the key anatomical structures and ligaments of support in the pelvis. There are also important distinct images and visual cues that can help guide the surgeon while performing common gynecologic procedures.