Anatomic basis of laparoscopic surgery in the male pelvis

Laparoscopic surgery of the male pelvis remains a risky procedure, with around 15% of perioperative complications, as compared to 0.03% in laparoscopic surgery for gynecologic and obstetric conditions. Many of these complications are due to the surgeon's being faced with an unfamiliar anatomic situation in his approach through the laparoscopic operative field. We have added to the data of the literature our anatomic and clinical experience in order to define the anatomic basis of surgical risk in this type of procedure. While dissection lateral to the iliac vessels (surgery of the spermatic cord) is safe, dissection medial to these vessels is more risky because of the confined anatomic relationships and their variations (particularly vascular anomalies and variable relations of the ureter).