Anatomic relationships of the pelvic autonomic nervous system in female cadavers: clinical applications to pelvic surgery

Ripperda, Christopher M.; Jackson, Lindsey N.; Phelan, John N.; Carrick, Kelley; Corton, Marlene M.

doi:10.1016/j.ajog.2016.12.002

Cited by 45 publications

(43 citation statements)

References 30 publications

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“…The superior hypogastric plexus (SHP) is a preaortic nervous plexus formed by two lateral and one median root [17] around the level of aortic bifurcation [18]. The lateral roots originate mainly from the lowest lumbar splanchnic nerves (LSNs) [2] and contain a sympathetic component [17].…”

Section: Introductionmentioning

confidence: 99%

Anatomy of the superior hypogastric plexus and its application in nerve-sparing paraaortic lymphadenectomy

Kim

Nam²,

Lee³

et al. 2021

Folia Morphol

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Background:The purpose of this study was to clarify the anatomy of the superior hypogastric plexus, which would contribute to advancement of nerve-sparing paraaortic lymphadenectomy. Materials and methods:Eighteen cadavers were dissected and morphometrically analyzed based on photographic images. Anatomical landmarks such as aortic bifurcation, transitional points of abdominal aorta to bilateral common iliac arteries, and cross point of the right ureter and pelvic brim, and cross point of sigmoid mesentery and pelvic brim were selected as reference points. Results:The left lowest lumbar splanchnic nerve was located more laterally to transitional point of abdominal aorta to in 11/18 specimens, whereas the right lowest lumbar splanchnic nerve passed onto the right transitional point in only one specimen. The lowest lumbar splanchnic 2 nerves or the superior hypogastric plexus covered the aortic bifurcation in 11/18 specimens. The superior hypogastric plexus was separate from the cross point of right ureter and pelvic brim as well as cross point of sigmoid mesentery and pelvic brim. Conclusions:The SHP is at risk of injury during paraaortic lymphadenectomy because of its topography. Preservation of the superior hypogastric plexus regarding its anatomic basis during paraaortic lymphadenectomy is required.

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Section: Introductionmentioning

confidence: 99%

Anatomy of the superior hypogastric plexus and its application in nerve-sparing paraaortic lymphadenectomy

Kim

Nam²,

Lee³

et al. 2021

Folia Morphol

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“…Nevertheless, preservation of the autonomic pelvic nerves during RPC is of utmost importance in both malignant and non-malignant patients with FAP or UC, to maximize the functional outcomes (Fig. 10), but the anatomic variability and the inability to visualize the small fibers of the inferior hypogastric plexus may explain the occurrence of some postoperative visceral and sexual dysfunctions despite of careful dissection and adequate surgical technique (23). In the current series, colo-rectal malignancies at the time of ileal pouch-anal surgery were observed in 22.1% of patients, with a significantly higher incidence in the FAP group of patients, compared with the UC group (29.6% vs. 4.3%, p = 0.015).…”

Section: Resultsmentioning

confidence: 99%

Technical Issues and Early Outcomes of Restorative Proctocolectomy for Familial Adenomatous Polyposis and Ulcerative Colitis: The Largest Romanian Single-Team Experience

Dumitraşcu¹,

Stroescu²,

Tomulescu³

et al. 2019

chr

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RezumatIntroducere: Proctocolectomia totală restaurativă este un procedeu chirurgical complex folosit în cazul pacienţilor diagnosticaţi cu polipoză adenomatoasă familială şi rectocolită ulcero-hemoragică. Studiul de faţă îşi propune să analizeze elemente de tehnică chirurgicală, precum şi rezultatele postoperatorii imediate după proctocolectomia totală restaurativă, pe baza experienţei acumulate de către o singură echipă chirurgicală. Pacienţi şi Metodă: Datele tuturor pacienţilor cu proctocolectomia totală restaurativă efectuate de către o singură echipă chirurgicală în perioada 1991 -2018 au fost analizate retrospectiv, având în vedere existenţa unei baze de date cu intervenţii chirurgicale introduse prospectiv. Rezultate: Au fost incluşi în studiu un număr de 77 de pacienţi cu proctocolectomie totală restaurativă, dintre care 70,1% au avut diagnosticul de polipoză adenomatoasă familială. Numărul mediu anual de proctocolectomii totale restaurative a fost de 3,3 pentru echipa chirurgicală inclusă în studiu, şi 4,3 la nivel instituţional. Un rezervor de tip J a fost realizat la 93,5% dintre pacienţi; în 76,6% din cazuri rezervorul a fost realizat printr-o sutură manuală. Anastomoza ileo-anală a fost realizată printr-o sutură manuală în 81,8% dintre pacienţi. Ileostomia de protecţie s-a realizat la 92,2% dintre pacienţi iar mucosectomia la 84,4% dintre pacienţi. Complicaţii postoperatorii precoce au fost înregistrate în 36,4% dintre pacienţi, iar rata complicaţiilor severe a fost de 13%. Principalele complicaţii au fost reprezentate de complicaţiile septice având drept sursă rezervorul ileal sau anastomoza ileo-anală (18,2%), infecţiile de plagă (9,1%), ocluzia intestinală (6,5%) şi hemoragia (6,5%). Concluzii: Deşi proctocolectomia totală restaurativă rămâne un procedeu rareori practicat în România, totuşi, rezultatele postoperatorii imediate ale seriei noastre de pacienţi sunt comparabile cu cele întâlnite în centrele cu volum mare din lume. Aceste rezultate bune ale proctocolectomiei totale restaurative sunt consecinţa faptului că aceste proceduri au fost efectuate de către o echipă chirurgicala special antrenată, cu un volum mare de proceduri efectuate.Cuvinte cheie: proctocolectomie totală restaurativă, polipoză adenomatoasă familială, rectocolită ulcero-hemoragică, rezervor ileal, rezultate Abstract Background/ Aim: Restorative proctocolectomy (RPC) is a complex surgical procedure used to treat patients with ulcerative colitis (UC) and familial adenomatous polyposis (FAP). The present study aims to assess the technical issues and early outcomes of RPC for FAP and UC, in a relatively large single-team series of patients. Patients and Methods: The data of all patients with RPC performed by a single surgical team between 1991 and 2018 were retrospectively assessed from a prospectively maintained electronic database. Results: The study group included 77 patients with RPC, and 70.1% have had FAP. The average number of RPC per year was 3.3 for the surgical team and 4.3 for the institution. A J pouch was performed...

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“…The last columns depict the identifiability and level of agreement with positional references, anatomist, and radiologistNerve/ plexusRecords included in quantitative synthesisMain positional referenceIdentifiability (%) a Conform positional reference (%) b Level of agreement anatomist (Likert score 2)Level of agreement radiologist (Likert score 2)Lumbosacral plexusNANA20 (100)NA20 (100)20 (100)Sacral nervesNANA20 (100)NA20 (100)20 (100)Obturator nerve2 [11, 12]Appearance lateral to confluence of the internal and external iliac vein20 (100)20 (100)20 (100)20 (100)Sympathetic trunk4 [13–16]Entrance pelvis from either side of the lumbar spine dorsal from common iliac vein to course medial to sacral foramina19 (95)19 (100)19 (100)19 (100)Superior hypogastric plexus12 [7, 16–26]Division at or just below the level of the sacral promontory14 (70)14 (100)14 (100)14 (100)Hypogastric nerve12 [7, 16, 19, 21, 25–32]Course just medial to internal iliac vessels16 (80)16 (100)16 (100)16 (100)Inferior hypogastric plexus17 [7, 16, 21, 25–38]Ureter crosses, just before entering the bladder, anterior to the IHP…”

Section: Resultsmentioning

confidence: 99%

A step towards stereotactic navigation during pelvic surgery: 3D nerve topography

Wijsmuller

Giraudeau

Leroy³

et al. 2018

Surg Endosc

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BackgroundLong-term morbidity after multimodal treatment for rectal cancer is suggested to be mainly made up by nerve-injury-related dysfunctions. Stereotactic navigation for rectal surgery was shown to be feasible and will be facilitated by highlighting structures at risk of iatrogenic damage. The aim of this study was to investigate the ability to make a 3D map of the pelvic nerves with magnetic resonance imaging (MRI).MethodsA systematic review was performed to identify a main positional reference for each pelvic nerve and plexus. The nerves were manually delineated in 20 volunteers who were scanned with a 3-T MRI. The nerve identifiability rate and the likelihood of nerve identification correctness were determined.ResultsThe analysis included 61 studies on pelvic nerve anatomy. A main positional reference was defined for each nerve. On MRI, the sacral nerves, the lumbosacral plexus, and the obturator nerve could be identified bilaterally in all volunteers. The sympathetic trunk could be identified in 19 of 20 volunteers bilaterally (95%). The superior hypogastric plexus, the hypogastric nerve, and the inferior hypogastric plexus could be identified bilaterally in 14 (70%), 16 (80%), and 14 (70%) of the 20 volunteers, respectively. The pudendal nerve could be identified in 17 (85%) volunteers on the right side and in 13 (65%) volunteers on the left side. The levator ani nerve could be identified in only a few volunteers. Except for the levator ani nerve, the radiologist and the anatomist agreed that the delineated nerve depicted the correct nerve in 100% of the cases.ConclusionPelvic nerves at risk of injury are usually visible on high-resolution MRI with dedicated scanning protocols. A specific knowledge of their course and its application in stereotactic navigation is suggested to improve quality of life by decreasing the likelihood of nerve injury.Electronic supplementary materialThe online version of this article (10.1007/s00464-018-6086-3) contains supplementary material, which is available to authorized users.

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Anatomic relationships of the pelvic autonomic nervous system in female cadavers: clinical applications to pelvic surgery

Cited by 45 publications

References 30 publications

Anatomy of the superior hypogastric plexus and its application in nerve-sparing paraaortic lymphadenectomy

Anatomy of the superior hypogastric plexus and its application in nerve-sparing paraaortic lymphadenectomy

Technical Issues and Early Outcomes of Restorative Proctocolectomy for Familial Adenomatous Polyposis and Ulcerative Colitis: The Largest Romanian Single-Team Experience

A step towards stereotactic navigation during pelvic surgery: 3D nerve topography

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