New surgical approaches are being developed to solve old problems and often require surgeons to revisit familiar anatomy from an unfamiliar perspective or with a different understanding of complex anatomic relationships. Examples of innovative surgical approaches that require renewed understanding of anatomic relationships include laparoscopic or robotic surgery, midurethral incontinence slings that traverse the obturator or retropubic spaces, and prolapse kits that traverse pararectal and paravesical spaces. Anatomic alterations secondary to disease, congenital variation, or intraoperative complications may make familiar surgical territory suddenly seem foreign. All of these situations require surgeons to be perpetual students of anatomy, regardless of their breadth or depth of experience.
Several strategies for continuing education in anatomy are suggested: 1.
Review relevant anatomy before each surgical procedure.
2.
Study the gynecologic literature on an ongoing basis—numerous publications document the evolution of newer concepts regarding anatomic issues such as pelvic support.
3.
Operate with more experienced pelvic surgeons, particularly when incorporating new surgical procedures into practice.
4.
Periodically dissect fresh or fixed cadaveric specimens; this practice may be arranged through local or regional anatomy boards or medical schools or by special arrangement at the time of autopsy.
5.
Take advantage of newer computer-generated three-dimensional pelvic models and virtual reality interactive anatomic and surgical simulators, when available, to better understand functional anatomy and to help plan complicated surgical procedures (49,50).
1.
International Anatomical Nomenclature Committee. Nomina 3. Handa VL, Pannu HK, Siddique S, et al. Architectural differences anatomica. 6th ed. Edinburgh, Scotland: Churchill Livingstone, in the bony pelvis of women with and without pelvic ﬂoor disorders. 1989. Obstet Gynecol 2003;102:1283–1290.
2.
Sze EH, Kohli N, Miklos JR, et al. Computed tomography compari-4. Mattox TF, Lucente V, McIntyre P, et al. Abnormal spinal curvason of bony pelvis dimensions between women with and without genital ture and its relationship to pelvic organ prolapse. Am J Obstet Gynecol prolapse. Obstet Gynecol 1999;93:229–232. 2000;183:1381–1384.
5.
Nguyen JK, Lind LR, Choe JY, et al. Lumbosacral spine and pelvic inlet changes associated with pelvic organ prolapse. Obstet Gynecol 2000;95:332–336.
6.
Stein TA, Kaur G, Summers A, et al. Comparison of bony dimensions at the level of the pelvic ﬂoor in women with and without pelvic organ prolapse. Am J Obstet Gynecol 2009;200:241.e1–5.
7.
Thompson JR, Gibbs JS, Genadry R, et al. Anatomy of pelvic arteries adjacent to the sacrospinous ligament: importance of the coccygeal branch of the inferior gluteal artery. Obstet Gynecol 1999;94:973–977.
8.
DeLancey JOL, Kearney R, Chou Q, et al. The appearance of levator ani muscle abnormalities in magnetic resonance imaging after vaginal delivery. Obstet Gynecol 2003;101:46–53.
9.
Singh K, Jakub M, Reid WM, et al. Three dimensional assessment of levator ani morphologic features in different grades of prolapse. Am J Obstet Gynecol 2003;189:910–915.
10.