Comprehensive anatomy of the superior hypogastric plexus and its relationship with pelvic surgery landmarks: defining the safe zone around the promontory

Kutlu, Burak; Güner, Metin; Akyol, Cihangir; Güngör, Yiğit; Benlice, Çiğdem; Arslan, Metin; Açar, Hali̇l İbrahi̇m; Kuzu, Mehmet Ayhan

doi:10.1007/s10151-022-02622-z

Cited by 3 publications

(1 citation statement)

References 16 publications

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“…Fenestrated and cord-like shape morphology of SHP were observed, just like what Ripperda found in their study [ 18 ]. While Kutlu observed three patterns of SHP, including mesh, single and fiber, among which the mesh type is over 50% [ 19 ]. Correia et al proposed an original morphological classification with six types, based upon the anatomical arrangement of the nervous fibers [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Applied anatomy of female pelvic plexus for nerve-sparing radical hysterectomy(NSRH)

Ye,

Su,

Xiong

et al. 2023

BMC Women's Health

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Background Nerve-sparing radical hysterectomy(NSRH)has the advantage of reducing postoperative complications and improving postoperative quality of life. The separation and protection of the pelvic plexus in NSRH is extremely important and challenging. Methods 24 female cadaveric hemipelves were dissected. Morphologic patterns and compositions of pelvic plexus as well as relationship of pelvic plexus to the surrounding structures were observed and documented. Results Two patterns of superior hypogastric plexus were observed, including fenestrated and cord-like shape. The origin of bilateral hypogastric nerves were inferiorly to upper margin of promontory about 1.6 ± 0.1 cm and parallel to the ureter in front of the sacrum. Pelvic splanchnic nerves(PSN)from the second sacral nerve, the third sacral nerve and the forth sacral nerve were observed combing with the hypogastric nerves within the lateral rectal ligament. The sacral sympathetic trunk can be identified anteriorly or medially to the anterior sacral foramen. We identified the boundaries of pelvic plexus as following: the upper margin is formed by the PSNs from the third sacral nerve, posterior margin by inferior rectal artery, and anteriorly by vesical venous plexus. The uterine branches from pelvic plexus were observed accompanying with uterine artery, while other branches were inferiorly to the artery. The PSNs were located beneath the deep uterine veins within the cardinal ligament. The upper margin of pelvic plexus was observed directly approach to urinary bladder within the vesico-vaginal ligament as a single trunk accompanying with ureter, between the middle and inferior vesical veins. Conclusions Our study clarified the intricate arrangement, distribution and relationship of female pelvic plexus and the related structures to provide reference index for NSRH application. The innervation patterns of bladder and uterine were clarified, and by tracing these visceral branches of pelvic plexus, we suggest several new important land markers for NSRH.

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Section: Discussionmentioning

confidence: 99%

Applied anatomy of female pelvic plexus for nerve-sparing radical hysterectomy(NSRH)

Ye,

Su,

Xiong

et al. 2023

BMC Women's Health

View full text Add to dashboard Cite

show abstract

Safety and efficacy of ultrasound-guided superior hypogastric plexus block combined with conscious sedation in ambulatory patients undergoing percutaneous microwave ablation of uterine myomas: Study protocol for a single-center, double-blinded, randomized controlled trial

Yan,

Wang,

Zhang

et al. 2024

Heliyon

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Applied anatomy of female pelvic plexus for nerve-sparing radical hysterectomy（NSRH）

Fan

Xiong

et al. 2023

Preprint

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Background Nerve-preserving radical hysterectomy(NSRH)has the advantage of reducing postoperative complications and improving postoperative quality of life. The separation and protection of the pelvic plexus in NSRH is extremely important and challenging. Methods 24 female cadaveric hemipelvis were dissected. Morphologic patterns and compositions of pelvic plexus as well as relationship of pelvic plexus to the surrounding structures were observed and documented. Results Two patterns of superior hypogastric plexus were observed, including fenestrated and cord-like shape. The origin of bilateral hypogastric nerves were inferiorly to upper margin of promontory about 1.6 ± 0.1cm and parallel to the ureter in front of the sacrum. Pelvic splanchnic nerves(PSN)from the second sacral nerve, the third sacral nerve and the forth sacral nerve were observed combing with the hypogastric nerves within the lateral rectal ligament. The sacral sympathetic trunk can be identified anteriorly or medially to the anterior sacral foramen. We identified the boundaries of pelvic plexus as following: the upper margin is formed by the PSNs from the third sacral nerve, posterior margin by inferior rectal artery, and anteriorly by vesical venous plexus. The uterine branches from pelvic plexus were observed accompanying with uterine artery, while other branches were inferiorly to the artery. The PSNs were located beneath the deep uterine veins within the cardinal ligament. The upper margin of pelvic plexus was observed directly approach to urinary bladder within the vesicouterine ligament as a single trunk accompanying with ureter, between the middle and inferior vesical veins. Conclusions Our study clarified the intricate arrangement, distribution and relationship of female pelvic plexus and the related structures to provide reference index for NSRH application. The innervation patterns of bladder and uterine were clarified, and by tracing these visceral branches of pelvic plexus, we suggest several new important land markers for NSRH.

show abstract

Comprehensive anatomy of the superior hypogastric plexus and its relationship with pelvic surgery landmarks: defining the safe zone around the promontory

Cited by 3 publications

References 16 publications

Applied anatomy of female pelvic plexus for nerve-sparing radical hysterectomy(NSRH)

Applied anatomy of female pelvic plexus for nerve-sparing radical hysterectomy(NSRH)

Safety and efficacy of ultrasound-guided superior hypogastric plexus block combined with conscious sedation in ambulatory patients undergoing percutaneous microwave ablation of uterine myomas: Study protocol for a single-center, double-blinded, randomized controlled trial

Applied anatomy of female pelvic plexus for nerve-sparing radical hysterectomy（NSRH）

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