Skip to main content

Advertisement

Log in

Topographical relationships between the obturator nerve, artery, and vein in the lateral pelvic wall

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

The aims of this study were to determine the topographical relationships between the obturator nerve (ON), artery (OA), and vein (OV) in the lateral pelvic wall.

Methods

One hundred and fifty hemipelvises of 84 Korean cadavers were dissected.

Results

The ON, OA, and OV ran in that order (from upper to lower) within the lateral pelvic wall in 46.7 % of specimens. In 32 % of cases, the three structures were separated at the posterior portion of the wall and then converged toward the obturator canal (OC). In 10 %, the OA and OV were in contact with each other and separate from the ON; in 2 %, the ON was contiguous with the OA and separate from the OV; in 2.7 %, all three structures were in contact with each another. Alternately, the order of ON, OA, and OV was altered in the lateral pelvic wall in 41.3 % of specimens. Finally, in 12 % specimens, either the OA or OV or both were absent from the lateral pelvic wall.

Conclusions

The possibility of the presence of either the OA or OV being between the ON and the external iliac vein, and the potential contact between the ON and either the OA or OV in the lateral pelvic wall, should be borne in mind during pelvic procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Abbreviations

ON:

Obturator nerve

OA:

Obturator artery

OV:

Obturator vein

References

  1. Anson BJ (1966) Morris’ human anatomy, 12th edn. Blackiston Division McGraw-Hill Book Co., New York

    Google Scholar 

  2. Woodburne RT, Burkel WE (1988) Essentials of human anatomy, 8th edn. Oxford University Press, New York

    Google Scholar 

  3. Rouvière H, Delmas A (1992) Anatomie Humaine. Tome II. Tête et Cou. 13e edn. Masson, Paris

  4. Hollinshead WH, Rosse C (1985) Textbook of anatomy, 4th edn. Harper & Row Purbishers, Philadelpia

    Google Scholar 

  5. Berberoǧlu M, Uz A, Ozmen MM, Bozkurt C, Erkuran C, Taner S, Tekin A, Tekdemir I (2001) Corona mortis. Surg Endosc 15:72–75

    Article  PubMed  Google Scholar 

  6. Rusu MC, Cergan R, Motoc AGM, Folescu R, Pop E (2010) Anatomical considerations on the corona mortis. Surg Radiol Anat 32:17–24

    Article  PubMed  Google Scholar 

  7. Sañudo JR, Mirapeix R, Rodriguez-Niedenfuehr M, Maranillo E, Parkin IG, Vazquez T (2011) Obturator artery revisited. Int Urogynecol J 22:1313–1318

    Article  PubMed  Google Scholar 

  8. Missankov AA, Asvat R, Maoba KI (1996) Variations of the pubic vascular anastomoses in black south Africans. Acta Anat 155:212–214

    Article  CAS  PubMed  Google Scholar 

  9. Gilroy AM, MacPherson BR, Ross LM (2008) Atlas of anatomy. Thieme, Stuttgart

    Google Scholar 

  10. Fishman JR, Moran ME, Carey RC (1993) Obturator neuropathy after laparoscopic pelvic lymphadenectomy. Urology 42:198–200

    Article  CAS  PubMed  Google Scholar 

  11. Querleu D, Ferron G, Rafii A, Bouissou E, Delannes M, Mery E, Gladieff L (2008) Pelvic lymph node dissection via a lateral extraperitoneal approach: description of a technique. Gynecol Oncol 109:81–85

    Article  PubMed  Google Scholar 

  12. Ricciardi E, Jakimovska M, Maniglio P, Schimberni M, Frega A, Kobal B, Moscarini M (2012) Laparoscopic injury of the obturator nerbe during fertility-sparing procedure for cervical cancer. World J Surg Oncol 10:177

    Article  PubMed Central  PubMed  Google Scholar 

  13. Nezhat FR, Chang-Jackson SCR, Acholonu UC Jr, Vetre PF (2012) Robotic-assisted laparoscopic transaction and repair of an obturator nerve during pelvic lymphadenectomy for endometrial cancer. Obstet Gynecol 119:462–464

    Article  PubMed  Google Scholar 

  14. Saliviero M, Steinberg AP, Kaouk JH, Desai MM, Hammert WC, Gill I (2004) Laparoscopic injury and repair of obturator nerve during radical prostatectomy. Urology 64:1030.e11–1130.e12

    Google Scholar 

  15. Ludwig W, Tewari A (2013) Retraction of external iliac vessels and obturator nerve with the vas deferns during extended pelvic lymph node dissection in robot-assisted radical prostatectomy. Urology 81:1369–1371

    Article  PubMed  Google Scholar 

  16. Agur AMR (1991) Grant’s atlas of anatomy, 9th edn. Williams & Wilkins, Baltimore

    Google Scholar 

  17. Williams PL (1995) Gray’s anatomy. Churchill Livingstone, Edinburgh

    Google Scholar 

  18. Putz R, Pabst R (2000) Sobotta atlals of human anatomy, vol 2. 13th edn. Lippincott Williams & Wilkins, Philadelphia

  19. Lallas CD, Pe ML, Thumar AB, Chandrasekar T, Lee FC, McCue P, Gomella LG, Trabulsi EJ (2011) Comparison of lymph node yield in robot-assisted laparoscopic prostatectomy with that in open radical retropubic prostatectomy. BJU Int 107:1136–1140

    Article  PubMed  Google Scholar 

  20. Yee DS, Katz DJ, Godoy G, Nogueira L, Chong KT, Kaag M, Coleman JA (2011) Extended pelvic lymph node dissection in robotic-assisted radical prostatectomy: surgical technique and initial experience. Urology 75:1199–1204

    Article  Google Scholar 

  21. Kitagawa R, Kim D, Reid N, Kline D (2009) Surgical management of obturator nerve lesions. Neurosurgery 65:A24–A28

    Article  PubMed  Google Scholar 

  22. Mirilas P, Skandalakis JE (2010) Surgical anatomy of the retroperitoneal spaces, part III: retroperitoneal blood vessels and lymphatics. Am Surg 76:139–144

    PubMed  Google Scholar 

  23. Weingärtner K, Ramaswamy A, Bittinger A, Gerharz EW, Vöge D, Riedmiller H (1996) Anatomical basis for pelvic lymphadenectomy in prostate cancer: results of an autopsy study and implications for the clinic. J Urol 156:1969–1971

    Article  PubMed  Google Scholar 

  24. Briganti A, Chun FK, Salonia A, Suardi N, Gallina A, Da Pozzo LF, Roscigno M, Zanni G, Valiquette L, Rigatti P, Montorsi F, Karakiewicz PI (2006) Complications and other surgical outcomes associated with extended pelvic lymphadenectomy in men with localized prostate cancer. Eur Urol 50:1006–1013

    Article  PubMed  Google Scholar 

  25. Fricker RM, Troeger H, Pfeiffer KM (1997) Obturator nerve palsy due to fixation of an acetabular reinforcement ring with transacetabular screws. A case report. J Bone Joint Surg Am 79:444–446

    Article  CAS  PubMed  Google Scholar 

  26. Grant P, Røise O, Ovre S (2001) Obturator neuropathy due to intrapelvic extrusion of cement during total hip replacement - report of 2 patients. Acta Orthop Scand 72:537–540

    Article  CAS  PubMed  Google Scholar 

  27. Jirsch JD, Chalk CH (2007) Obturator neuropathy complicating elective laparoscopic tubal occlusion. Muscle Nerve 36:104–106

    Article  PubMed  Google Scholar 

  28. Akata T, Murakami J, Yoshinaga A (1999) Life-threatening haemorrhage following obturator artery injury during transurethral bladder surgery: a sequel of an unsuccessful obturator nerve block. Acta Anaesthesiol Scand 43:784–788

    Article  CAS  PubMed  Google Scholar 

  29. Daneshgari F, Kong W, Swartz M (2008) Complications of mid urethral slings: important outcomes for future clinical trials. J Urol 180:1890–1897

    Article  PubMed  Google Scholar 

  30. Walters MD, Tulikangas PK, LaSala C, Muir TW (2001) Vascular injury during tension-free vaginal tape procedure for stress urinary incontinence. Obstet Gynecol 98:957–959

    Article  CAS  PubMed  Google Scholar 

  31. Negura A, Andreescu G, Marderos GG, Marderos GH, Mǎrgǎrit L (1993) Hemorrhagic risks in the Burch procedure. Int Urogynecol J 4:310–313

    Article  Google Scholar 

  32. Tantchev LS, Gorchev GA, Tomov ST, Radionova ZV, Velkova AS (2013) Aberrant obturator vessels in minimally invasive pelvic lymph node dissection. Gynecol Surg 10:273–278

    Article  Google Scholar 

Download references

Acknowledgments

The authors thank Prof. In-Hyuk Chung and Mr. Seong-In John for their help in dissecting specimens and preparing figures.

Conflicts of interest

None

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to U-Young Lee.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Won, HS., Kim, JH., Lee, UY. et al. Topographical relationships between the obturator nerve, artery, and vein in the lateral pelvic wall. Int Urogynecol J 27, 213–218 (2016). https://doi.org/10.1007/s00192-015-2806-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-015-2806-6

Keywords

Navigation