8 Seventh rib limiting factor for most patients is the bony confines of the operative field. For instance, a large patient may have a wide and shallow pelvis, making her an acceptable candidate for a radical hysterectomy. This may be determined before the incision by noting the distance between the anterior iliac crests in relation to the distance from the crest to the ischial tubercle. Similarly, for vaginal procedures, emphasis should be placed on the distance between the ischial tubercles and the angle of the pubic arch. The best way of assessing the patient preoperatively is by recognizing the significance of the bony and cutaneous landmarks of the operative field.

11 10 3

11 10 3

Ram Ischio Pubian

Figure 10

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