Digital anatomic study of the ureter relative to bifurcation of the common iliac artery in females

Introduction: Laparoscopic salpingo-oophorectomy and pelvic lymphadenectomy place the ureter at risk. Although traditional anatomic studies indicate that ureters generally cross over the common iliac artery in the pelvic inlet, the view is often different during surgery. Hence, digital three-dimensional models have been utilized to solve this conundrum. Our study aimed to evaluate the anatomic relation between the iliac artery and the ureter in the pelvic inlet. Material and methods: A medical image processing system processed data collected from 129 female patients, and digital 3D models of the iliac artery and ureter were used to study their anatomic relation. Left- and right-side data were compared using Pearson's chi(2) analysis. Results: Two different anatomic relations were found immediately posterior to the ureter: Common iliac arteries were present in 33.2% and external iliac arteries in 76.8%. The mean distances from the point at which the ureter crossed over the iliac artery until the bifurcation of the artery was 8.8 +/- 12.2 mm in the left pelvis and 12.4 +/- 10.8 mm in the right pelvis - different from that of the traditional anatomic study. Conclusion: In the future, these models and digital anatomical data could help avoid surgical complications.