Handa 9781496386441 Full Sample Chap 1

24

SECTION I  Preparing for Surgery

The ovary has a cuboidal to columnar covering and consists of a cortex and medulla. The medullary portion is primarily fibromuscular, with many blood vessels and much connective tissue. The cortex is composed of a more specialized stroma, punctuated with follicles, cor- pora lutea, and corpora albicantia. The round ligaments of uterus are extensions of the uterine musculature and represent the homolog of the gubernaculum testis. They begin as broad bands that arise on each lateral aspect of the anterior corpus. They assume a more cylindrical shape before they enter the retroperitoneal tissue, where they pass lateral to the deep inferior epigastric vessels and enter each deep (internal) inguinal ring. After traversing the inguinal canal, they exit the superficial inguinal ring and enter the subcutaneous tissue of the labia majora. They have little to do with uterine support. The ovaries and tubes constitute the uterine adnexa. They are covered by a specialized series of peritoneal folds called the broad ligament. During embryonic development, the paired müllerian ducts and ovaries arise from the lateral abdominopelvic walls. As they migrate toward the midline, a mesentery of peritoneum is pulled out from the pelvic wall from the cervix on up. This leaves the midline uterus connected on either

side to the pelvic wall by a double layer of peritoneum, called the broad ligament; these ligaments are described under the section on supportive tissues and cleavage planes. At the superior margin of these two folds, called the broad ligament, lie the uterine tubes, round ligaments, and ovaries ( FIG. 1.24 ). The cardinal and uterosacral ligaments are at the lower margin of the broad ligament. These structures are visceral ligaments; therefore, they are composed of varying amounts of smooth muscle, vessels, connective tissue, nerves, and other structures. They are not the pure ligaments associated with joints in the skeleton. The ovary, tube, and round ligament each have their own separate mesentery, called the mesovarium, meso- salpinx, and mesoteres, respectively. These are arranged in a consistent pattern, with the round ligament placed ventrally, where it exits the pelvis through the inguinal ligament, and the ovary placed dorsally. The tube is in the middle and is the most cephalic of the three structures. At the lateral end of the uterine tube and ovary, the broad lig- ament ends where the infundibulopelvic ligament blends with the pelvic wall. The cardinal ligaments lie at the base of the broad ligament and are described under the section on supportive tissues and cleavage planes.

I

Suspensory ligament of ovary

Copyright © 2019 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.

FIGURE 1.24  Broad ligament composition.

0004290808.INDD 24

4/3/2019 9:30:46 PM