Standardization of laparoscopic pelvic examination.

OBJECTIVE

To propose a novel standardized and reproducible system to be used for reporting positive and negative findings during diagnostic and operative laparoscopy based on anatomical landmarks.

DESIGN

Video presentation of clinical article. The video uses animation and surgical cases to demonstrate a systematic examination of the female pelvis based on anatomical landmarks to establish a standardized way of reporting.

SETTING

Tertiary care referral center.

PATIENT(S): Not applicable.

INTERVENTION(S): Not applicable.

MAIN OUTCOME MEASURE(S): Not applicable.

RESULT(S): This video demonstrates a proposal to standardize laparoscopic pelvic examinations. The pelvis is topographically divided into two midline zones (zone I and II) and two paired (right and left) lateral zones (zone III and IV). Zone I is the area between the two round ligaments from their origin at the uterine cornua to their insertion in the deep inguinal rings. Zone II is the area between the two uterosacral ligaments from their origin from the back of the uterus to their insertions in the sacrum posteriorly. Zone III is the area between the uterosacral ligament inferiorly and the entire length of the fallopian tube and the infundibulo pelvic ligament superiorly. Zone III contains the tubes and the ovaries. Zone IV is the triangular area lateral to the fallopian tube and the infundibulo pelvic ligament and medial to the external iliac vessels up to the round ligament.

CONCLUSION(S): This system is based on standardized anatomical landmarks. It is user friendly, reproducible and allows systemic search of the pelvis to document the presence or absence of any pathology. It could improve diagnostic accuracy, help diagnose lesions in anatomically challenging locations, and provide the required standardization with its clinical and academic advantages. Video is available at http://fertstertforum.com/bedaiwym-standardization-laparoscopic-pelvic-examination/.