ABSTRACT
Many gynecologists use a procedure-based approach to benign gynecologic surgery with limited use of pelvic anatomy. While many operations can be performed safely by this method, surgical skills often plateau before the surgeon has the ability to confidently manage complex pathology with minimal complications. An anatomic surgical approach puts emphasis on using fixed anatomic landmarks in the pelvis to safely dissect and identify vital structures from areolar connective tissue and pathology. The vital structures of the pelvis are primarily located in the retroperitoneal space of the pelvic sidewall. Once they are located, the remainder of the operation becomes relatively straightforward and safe, enabling successful completion of complex surgical procedures such as peritoneal resection of cul-de-sac endometriosis, adhesiolysis of severe adnexal adhesions or remnant ovary, sacrocolpopexy, and laparoscopic hysterectomy of large uterus.
