Surgical anatomy and dissection techniques for laparoscopic surgery.

All anatomically important pelvic structures lie embedded in the fatty-fibrous connective tissue of the retroperitoneum from which they may be freed by blunt dissection in the correct tissue planes. By relying on fixed laparoscopic landmarks, the correct surgical planes of dissection can be found, and all vital structures freed and identified by a systematic dissection consisting of a precise sequence of operative steps. Once the retroperitoneal dissection has been completed and all vital structures identified, most gynecologic operations can be carried out safely and without much difficulty laparoscopically. A nonanatomical approach to laparoscopic pelvic surgery may be easier to learn, but it is neither very versatile nor very safe except in the simplest of cases.