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 dissec
tion can be found, and all vital structures freed and identified by a
systematic dissection consisting of a precise sequence of operative st
eps. Once the retroperitoneal dissection has been completed and all vi
tal structures identified, most gynecologic operations can be carried
out safely and without much difficulty laparoscopically. A nonanatomic
al 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.