Anatomical basis of female pelvic cavity for nerve sparing radical hysterectomy

Li, Haili; Jia, Jianxin; Xiao, Yanlai; Kang, Lin; Cui, Huixian

doi:10.1007/s00276-014-1405-4

Cited by 12 publications

(11 citation statements)

References 25 publications

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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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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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“…The deep UV is said to be more robust and the principal functional component of the uterine venous drainage. 24 Li et al reported up to six tributaries forming the deep UV 25 ; three branches were reported the most common number of tributaries of the deep UV (63.3%; n = 15). 25 The UV joins the IIV at various locations and in various numbers, that is, occasionally as multiple vessels.…”

Section: Uterine Veinmentioning

confidence: 98%

“…24 Li et al reported up to six tributaries forming the deep UV 25 ; three branches were reported the most common number of tributaries of the deep UV (63.3%; n = 15). 25 The UV joins the IIV at various locations and in various numbers, that is, occasionally as multiple vessels. During the retrieval of the uterus from an LD, multiple UV may pose a technical difficulty because the UV may be located both ventrally and dorsally to the ureter.…”

Section: Uterine Veinmentioning

confidence: 98%

“…The two types of recognized UV are the deep UV and the superficial UV. [23][24][25][26] The discriminating structure running between the deep and superficial UV is the ureter. The deep UV is said to be more robust and the principal functional component of the uterine venous drainage.…”

Section: Uterine Veinmentioning

confidence: 99%

“…85 The UV are often located both ventrally and dorsally to the ureter. [23][24][25][26]28,29 If so, one or more UV must be transected to enable the procurement of the graft without damaging the ureter. The divided UV may need to be re-anastomosed on a back-table.…”

Section: Clinical Experience With Human Utxmentioning

confidence: 99%

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Human uterine vasculature with respect to uterus transplantation: A comprehensive review

Křístek

Johannesson

Novotný

et al. 2020

J of Obstet and Gynaecol

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Due to the novelty of uterus transplantation, data on preferable inflow and outflow of the graft are limited. This paper reviews the technique, type of vessels and the outcome. A systematic search of the PubMed database was conducted. We extracted and analyzed data on the arteries and veins utilized, types of anastomosis, types of donors, complications and the outcome. Thirty eight sources reported 51 human uterine transplantations, 10 graft thromboses and 25 live births. Inflow was established with two uterine arteries (UA) with/without the anterior division of the internal iliac artery in 62% (n = 31) of cases, two UA arteries with a segment/patch of the internal iliac artery in 34% (n = 17) of cases or two UA with a conduit in 4% of cases (n = 2). Both cases with a conduit developed thrombosis (n = 2). Arterial thrombosis/ischemia developed in 8 of the 51 cases. In 50% of cases with arterial thrombosis, atherosclerosis was identified as a possible cause. Outflow was established by two internal iliac veins with patches/segments in 27.5% of cases (n = 14) followed by two utero-ovarian veins in 25.5% (n = 13). Venous thrombosis occurred in 3 of the 51 cases. Uterine arteries with/without anterior division of the internal iliac artery were the most frequent arteries used for inflow and produced the highest patency rate. The presence of atherosclerosis and complex arterial reconstruction was associated with a high rate of arterial thrombosis. None of the veins utilized in the procedures appeared to be superior. There are insufficient data to draw a definite conclusion.

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Preserving Sexual Function and Continence during Radical Hysterectomy

Landoni

Zanagnolo

Soligo

2016

Functional Urologic Surgery in Neurogenic and Oncologic Diseases

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IntroductionCervical cancer is, after breast cancer, the second highest worldwide female malignancy. The incidence has been increasing gradually over recent years, with younger patients resulting affected. Thus, it is becoming one of the most deadly cancer globally [ 1 -4 ].The age-adjusted incidence rate rises rapidly in the third decade of life to approximately 20 cases per 100,000 and then increases slowly to 30 through the ninth decade. Although cervical cytology may potentially reduce the mortality rate of cervical cancer by 80 %, this procedure has only been fully implemented in few countries because of its costs and logistical problems resulting from the high incidence of cervical cancer precursors [ 5 ].Various types of radical surgery (RS), such as radical hysterectomy, radical trachelectomy, and radical parametrectomy, have shown 5-year survival rates ranging between 75 and 90 % [ 1 , 5 , 6 ], remaining the standard treatment for patients with early-stage cervical cancer [ 7 -9 ]. However, RS is known to cause urinary dysfunctions, such as bladder hypotonia, urinary incontinence, and abnormal sensation, in 12-85 % of patients [ 10 -12 ]. Furthermore, bowel dysfunctions, such as constipation, have been reported in 5-10 % of patients after RS [ 13 , 14 ].Considerable sexual dysfunctions, including decrease in sexual interest, orgasm, and vaginal dryness, may also be reported after RS. The sexual activity impairment thus results in substantial distress [ 15 ]. Urinary, anorectal, and sexual dysfunctions are known to be caused, during RS, by the disruption of sympathetic and parasympathetic

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Anatomical basis of female pelvic cavity for nerve sparing radical hysterectomy

Abstract: The deep uterine vein is suggested as an anatomical landmark during surgery, to process the CL and preserve the pelvic splanchnic nerves. The middle and inferior vesical veins can be used as the landmark to preserve the vesical branch of the IHP.

Cited by 12 publications

References 25 publications

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

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

Human uterine vasculature with respect to uterus transplantation: A comprehensive review

Preserving Sexual Function and Continence during Radical Hysterectomy

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