 Good day everybody. Dr. Sajja Sanyal, Professor Department Chair. So this is going to be a preliminary dissection of the pelvis and I'm going to demonstrate quite a few unique structures. This is a supine caliber. I'm standing on the right side. Camera person is on the left side. Let's start off with this structure, which I have lifted up here. This middle portion, this is the median umbilical legament, which is the remnant of the urechus, which is derived from the allantoi embryonic. This arises from the apex of the bladder. So this is the apex and this structure then goes towards the umbilicus and we have turned it down. Then we have these two structures on either side of them. These are the medial umbilical ligaments, which are the distal portions of the umbilical artery, which have become fibroids. The proximal portion of the umbilical artery is patient, which we shall come to later. So we can see these three structures are meeting at the umbilicus like this. In actual life, these three structures are located inside the anterior abdominal wall like this, where my hand is located and they are retroperitoneal. So therefore, there is a depression between the medial umbilical ligament and the medial umbilical ligaments on either side. Those depressions are above the bladder. So therefore, they are referred to as the supra vesicle fossa, which are potential sides of herniation. Now let's come to the next structure that we can see here. So for that, I will bring your attention to the right side. We can see these structures coming out from this place here. This is the fascia transversalis and this is the opening in the fascia transversalis, which is the internal inguinal ring. We can see emerging from the internal inguinal ring, we have these two structures. This is the gonadal artery, the testicular artery in the testicular vein and we can trace it from here. And also emerging through the internal ring is this structure going medially. This is the ductus difference. To bring you up to speed again on this side, again we can see the same structure. We can see the ductus difference going medially and we can see the gonadal vessels going laterally, coming through the internal ring. So therefore, we have a triangular place, which is again seen on the internal surface of the anterior abdominal wall and that is visible only during laparoscopic surgery of inguinal hernia. This triangular space is referred to as the triangle of doom. This triangle of doom is bounded laterally by the gonadal vessels medially by the ductus difference and inferiorly there will be a fold of petronium in living situation and deep to this triangle of doom will be these two structures namely the external iliac artery and the external iliac vein. To show the same thing on this side, this is the medial boundary of the triangle of doom. This is the lateral boundary of triangle of doom and the floor of the triangle of doom is formed by the external iliac artery and external iliac vein. This is called the triangle of doom because during laparoscopic repair of inguinal hernia, when we have reduced the sac, we should not put staples to reinforce the posterior inguinal wall because if we put staples we might puncture through and injure the external iliac vessels with horrendous bleeding. That is why it is called the triangle of doom. This structure which I have picked up here, this is the spermatic cord on the right side and when I am pulling we can see it is exerting traction on the gonadal vessels and the ductus difference because they all go through the internal ring and they go into the spermatic cord but we have not dissected out the spermatic cord. The next point which I would like to draw your attention to is this structure which I have lifted up here. This is the right ureter and same thing on this side this is the left ureter so we can see that the ureter on the right side is being crossed over by the ductus difference here and similarly the ureter on the left side is being crossed over by the ductus difference. The ductus difference is supposed to be anterior which it is and the ureter is supposed to go posterior to the ductus difference so this is the relationship between the ureter and the ductus difference. Embryological reason for this is during development kidneys which are developed from below they rise up while at the same time the test is which developed in the abdomen they descend down so therefore these two structures they cross each other. This is rarely a potential site of obstruction of the ureter by the ductus difference. The next point is if you were to take a look at the pelvis proper we see this is the posterior surface or the base or the fundus of the bladder this was covered by peritonia which we have removed and this is the rectum so therefore this is the rectovercycle pouch and if you were to see closely you will see 75 deposits here which most of which we have removed already. Additionally this cadaver also had plenty of intra vascular thrombosis as we can see in this external iliac vein this external iliac vein and there were also extra vascular collections of blood. These plus a few other findings indicate to us that most probably he had hemorrhagic necrotizing pancreatitis and that's why we have these 75 deposits and that is the reason many of these anatomical structures are highly distorted. Next structure which I would like to draw your attention to is to again focus on the internal ring. We know that going media to the internal ring is supposed to be the inferior epigastric vessels. This is the upturned surface of the rectus abdominis muscle and we can see the inferior epigastric vessels are running here and if you trace then we find that the inferior epigastric vessel is highly tortuous here because of previous surgery and this is the origin of the inferior epigastric artery from the external iliac artery and the inferior epigastric vein arising from the external iliac vein. The next thing I will draw your attention to is on the right side. If you take a close look this structure which I have lifted up here this one this is the operator nerve and we can see it is coming from the lumbar plexus and is going all the way across from the lateral wall of the pelvis and if you trace the operator nerve it is disappearing in foremen that is the operator foremen. This operator nerve is accompanied by the operator artery and the operator vein and I'm going to put this probe inside the operator foremen. The probe is going very easily inside so I pushed it inside the operator foremen. Ideally we are supposed to see it on the right side. We cannot see it but we can feel it and we can see the movement here. Probe has gone deep to the erector magnus so this is the course that has been taken by the operator vessels when they come to the medial compartment of the thigh and they supply the medial muscles namely the erector brevis, erector longus, erector magnus, gracilis etc. So this is the operator foremen. These are the structures that we can see in this particular dissection. Thank you very much for watching Dr. Sanjay Sanyal signing out. Mr. Kendall Cumberbatch is the camera person. If you have any questions or comments please put them in the comment section below. Have a nice day.