Background: Anatomical variations are defined as atypical morphologic and
positional presentations of anatomical entities. Pelvic anatomical variations encountered
during abdominal hysterectomy can be of clinical interest, given that
misidentification of certain structures can lead to iatrogenic injuries and postoperative
sequelae. The aim of the present study was to detect and highlight the
anatomical structures of interest and their variations to the surgeon performing
abdominal hysterectomy for benign conditions.
Materials and methods: A narrative review of the literature was performed
including reports of anatomical variations encountered in cadavers, by surgeons
during abdominal hysterectomy and radiologists on computed tomography
angiography, searching within a 10-year span on PubMed database. Studies regarding
the treatment of malignant conditions requiring lymphadenectomy and
different modes of surgical approach were reviewed with regards to the aspects
relevant to benign conditions. The search was extended to the reference lists of
all retrieved articles.
Results: Ureters and the uterine arteries, due to anatomical variations, are the
anatomical structures most vulnerable during abdominal hysterectomy. Specifically,
the ureters can present multiplications, retroiliac positionings and ureteric
diverticula, whereas, the uterine arteries can present notable variability in their
origins. Such variations can be detected preoperatively or intraoperatively.
Conclusions: Although rare, the presence of anatomical variations of the uterine
arteries and ureters can increase the possibility of complications should they escape
detection. Intraoperative misidentification could lead to improper dissection or
ligation of the affected structures. Knowledge of these variations, coupled with
extensive preoperative investigation and intraoperative vigilance can minimise the
risk of complications.