Anatomy of Space of Pelvic Sidewall

The lateral retroperitoneal space offers an optimal and secure pathway for pelvic lymph node dissection, ureter exposure, handling the suspensory ligament of the ovary, as well as addressing lateral pelvic organ exposure and treatment. By medially pulling the suspensory ligament of the ovary and laterally and cranially manipulating the round ligament, the lateral retroperitoneal space becomes accessible between the external iliac artery and the psoas major muscle. Gradual sharp dissection of this space unveils the suspensory ligament and the ureter, enabling the safe transection of the suspensory ligament along the iliac vessel surface. Further dissection within this space toward the posterior and caudal direction gradually reveals the internal iliac artery and the lateral umbilical ligament, laying the groundwork for subsequent exposure and management of the obturator space and lateral parametrium (Fig. 4.1).