The Modified Pararectus Extraperitoneal Incision in Gynecological Surgery

The extraperitoneal approach has been successfully employed by general surgeons, urologists, and orthopedic surgeons. In obstetrics and gynecology, this approach has been utilized for cesarean section, pelvic lymph node dissection, and drainage of extraperitoneal fluid collection including pelvic abscess, hematoma, and lymphocysts. With advancements in the use of antibiotics, imaging and image-guided drainage techniques the frequency of this approach has been reduced. However, it remains a valuable option in specific clinical situations related to gynecological surgery. This article provided a detailed description of the extraperitoneal technique, encompassing relevant anatomy and surgical considerations that are further illustrated in the accompanying cadaveric video dissection. As demonstrated in the reported cases, this technique can be performed on either the right or left and can be extended superiorly or inferiorly as needed. Potential advantages of the extraperitoneal technique compared with intraperitoneal approaches included reduced morbidity.