00:01
First of all,
let's have a look at the ovaries.
00:05
So here again,
we're looking into the pelvis.
00:08
A slightly different position here,
because we're looking
into a left pelvis.
00:14
So we can see the bottom
right hand side of the screen,
we have the pubic symphysis again.
00:19
And then most posteriorly,
top left we have the sacrum.
00:23
So here we can see the bladder
and the uterus just to zoom out.
00:27
And this space between
these blood vessels,
and what we'll soon see
as the ureter
is known as the ovarian fossa.
00:34
So this region indicated here is
where the ovary will be located.
00:38
Superiorly, we'll find the
external iliac artery and vein.
00:42
So, superior,
also anterior to the ovary
will see these blood vessels.
00:48
Inferiorly, we'll see the
obturator artery and vein.
00:51
Notice the nerve isn't
included in this split space.
00:54
So, posteriorly,
we can see we have the
internal iliac vein and the ureter,
in this region here.
01:01
We can also include
the internal iliac artery
as a posterior boundary.
01:06
And then more anteriorly
and slightly inferiorly
we'll see we have the
broad ligament of the uterus.
01:12
So the ovary position
within that ovarian fossa
is surrounded by a
number of structures.
01:18
Superiorly, external iliac artery,
external iliac vein,
and a kind of
superior anterior position.
01:25
Anteroinferiorly of the
broad ligament of the uterus.
01:28
And then posteriorly,
we have a number of
blood vessels in the ureter.
01:32
And then inferiorly we have
the obturator artery and vein.
01:36
A key structure that we're
missing in the moment though,
is the obturator nerve.
01:40
And the obturator nerve
lies lateral to the ovary.
01:44
So the obturator nerve is
compressed by the ovary medially,
and the pelvic wall laterally.
01:50
And increase in size of the ovary,
so hyperplasia of the ovary,
for example,
may cause compression
of the obturator nerve,
which will lead to a deficit within
the medial compartment of the leg.
02:04
Let's continue looking at the ovary
in relation to the uterine tube.
02:08
So here we can see the uterus.
02:10
We can see the
uterine tube passing out
from the uterus towards the ovary.
02:14
And here we can see the fimbriae,
these fingerlike projections
coming from the uterine tube
to associate themselves
with the ovaries on either side.
02:24
The superior pole of the ovary
is connected to the
posterior abdominal wall
via the suspensory ligaments,
and that has an important
blood vessel running
through it to supply the ovary,
the ovarian artery.
02:35
And the inferior pole here is
in connection to the bladder.
02:38
Not in a way
to transmit any substance,
like the sperm or the oocytes
coming from the ovary,
but as a way to support
the ovary in position
to hold it in place.
We have the ovarian ligament.
02:51
And this is a
thickening of peritoneum
forming the broad ligament.
02:54
Again, we'll come to
in a moment or two.
02:57
Here we have the medial surface
and the lateral surface
of the ovaries in position here.
03:03
So now let's have a look
at the ligaments of the pelvis
which we spoke about.
03:07
And importantly,
these are collectively within
what's known as the broad ligament.
03:12
Now, this essentially,
is a double layer of peritoneum
that is emerging lateral
to the body of the uterus.
03:20
We can see it has a
thickening anteriorly,
which is the round ligament.
03:25
And this will follow a similar path
to that of the ductus deferens
in the male.
03:29
So the round ligament is a
thickening of the broad ligament
and it passes through
the inguinal canal.
03:35
So it runs through
the deep inguinal ring,
the inguinal canal, and then
the superficial inguinal ring
to blend with the substance
on the mons pubis.
03:44
The fatty tissue around
the opening to the vagina.
03:47
So the mons pubis and
the various labia majora
around the lateral aspects
of the vaginal opening.
03:54
So the round ligament is
another important structure
that helps to hold
the uterus in place.
04:00
Another one that runs
directly anterior
from the cervix to the pubic bone
is the pubocervical ligament.
04:06
And we have a similar one
that runs posteriorly,
and this is the cardinal ligament.
04:10
And these ligaments are important
in holding the uterus in place.
04:15
Essentially,
the uterus is just wedged between
the bladder anteriorly
and the rectum posteriorly.
04:20
And to help hold it in
position to support it,
we have a number
of these ligaments.
04:26
A final ligament,
the uterosacral ligament
runs posteriorly
deep to the cardinal ligament.
04:31
It's running posteriorly
from the bladder
to the sacrum as
its name indicates.
04:37
So all of these
supportive structures
are kind of wrapped up within what
we know is the broad ligament.
04:43
So what is the broad ligament?
Essentially, the broad ligament
is a peritoneal ligament.
04:49
And if you remember from
the peritoneal topic,
a peritoneal ligament is a
double layer of peritoneum.
04:57
So what's happened here
is the peritoneum is
within the pelvic cavity
it's run over the bladder,
and then run over the uterus
to run over the rectum.
05:06
But as it runs over the uterus,
where it emerges laterally
and the uterus stops
those two layers.
05:14
So the layer that was on the
anterior aspect of the uterus,
and the layer those on the
posterior aspect of the uterus.
05:21
As they emerge laterally,
they just unite together
and they come together
as a double layer of peritoneum,
and that is the broad ligament.
05:31
So, it's literally,
as if I am the uterus,
and my arms outstretched
are the uterine tubes
and you were to place a
tablecloth over my head,
then here where the
tablecloth is positioned,
those two layers come together,
lateral to the uterus.
05:47
So they come together
lateral to the uterus.
05:49
This is our broad ligament.
05:51
And we have a number of
structures that run within
that double layer of peritoneum.
05:56
They run within the broad ligament
and they can become thickened.
06:01
So here we can see
the uterus in the middle.
06:04
Either side of it laterally,
we have the extension of peritoneum
forming the broad ligament.
06:11
Here where the fallopian tubes are,
we have that free border.
06:15
Just where the peritoneum
runs over the uterine tubes
is running over the uterine tubes.
06:21
This is the upper free border,
and it includes the uterine tubes.
06:27
Here the lower border is
continuous with the peritoneum.
06:30
So down on this lower border,
if it was anteriorly,
it would now extend
over the bladder.
06:36
If it was posteriorly,
it now extend over the rectum
forming those two pouches.
06:42
Within the broad ligament,
we can demarcated depending
on what it's covering.
06:48
The parts of the broad ligaments
surrounding the uterine tube
is the mesosalpinx
which we can see here.
06:54
We then have the mesovarium,
which surrounds the ovary.
06:57
And then a double layer
emanating away
from the body of the uterus
is the mesometrium.
07:02
So if the mesosalpinx
surrounding the uterine tube,
mesovarium surrounding the ovary,
and then the mesometrium,
a double layer,
passing away from the lateral
aspect of the uterine body.
07:14
Running within the broad ligament
is going to be some
various blood vessels.
07:17
So here we can see in the midline,
the uterus, and the vagina.
07:21
The ovaries are going to position
a lateral to the uterus
connected to either uterine tubes.
07:26
And we can see the relative arteries
that are supplying these regions.
07:29
So the uterus is supplied
by the uterine artery.
07:32
Here we can see a branch going to
the vagina, the vaginal branch.
07:36
Here we're going to see the
vaginal artery supplying the vagina
and connecting between these
two we have various anastomosis.
07:43
Here we have the ovarian artery.
07:45
Remember the ovarian artery is
coming from the abdominal aorta.
07:48
It passes down to supply the ovary
via the suspensory ligament.
07:52
And here we can see
it's giving off some branches
that supply the uterine tube.
The tubal branches.
07:57
Tubal branches
from the ovarian artery
supply the uterine tube.
08:01
And then we have the connection
of the ovarian artery
to the uterine artery
around the body of the uterus
via series of
connecting anastomosis.
08:11
So, the ovary, the vagina,
the uterus,
primarily supplied
by three branches:
ovarian artery, the uterine artery,
the vaginal artery,
which will form a
complex anastomosis network.