Laparoscopic evaluation of female pelvic neuroanatomy and autonomic plexuses in terms of gynecologic perspective

Kale, Ahmet; Başol, Gülfem; Usta, Taner; Gürbüz, Hande

doi:10.1177/2284026518798331

Cited by 5 publications

(9 citation statements)

References 39 publications

(52 reference statements)

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“…The lumbosacral trunk descends to join the S1 nerve root and contributes to the sacral plexus. The lumbosacral trunk also contributes fibers to the sciatic nerve . Traveling of these nerves in the pelvic region makes them vulnerable to injury because of the complex anatomy and closeness to vascular and bony structures.…”

Section: Discussionmentioning

confidence: 99%

Robot‐assisted laparoscopic management of a vascular entrapment of the sacral nerve roots causing pelvic pain

Usta

Ozkaynak

Kale

et al. 2019

J of Obstet and Gynaecol

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The aim of this case report is to demonstrate the robot-assisted laparoscopic decompression approach to treat the aberrant vessels entrapping the sacral nerves causing pelvic pain. A 34-year-old female patient had been complaining about pelvic pain on the left perineal region which was radiating to the sacral 1-2 nerves dermatome for 3 years. Decompression of sacral nerve roots and sciatic nerve was performed via robotassisted and a four-arm Da Vinci Si Surgical System laparoscopic approach. This case report is the first presentation of robot-assisted laparoscopic management of a vascular entrapment of the sacral nerve roots. The robotic technique offers, three-dimensional vision, improved maneuverability and enhanced ergonomics in the deepest area in the pelvis and could be a valid alternative to laparoscopy in the treatment of intrapelvic neurovascular entrapments.

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Section: Discussionmentioning

confidence: 99%

Robot‐assisted laparoscopic management of a vascular entrapment of the sacral nerve roots causing pelvic pain

Usta

Ozkaynak

Kale

et al. 2019

J of Obstet and Gynaecol

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“…The pelvic splanchnic nerves (PSN) (green), which constitute the sacral part of the parasympathetic system, arise from the sacral nerve roots and supply the left colon, anorectum, uterus/vagina, prostate/seminal vesicles, and bladder. The vagus nerve is the source of parasympathetic supply to the remaining visceral organs and gonads [ 17 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ].…”

Section: Neuroanatomy Of the Pelvismentioning

confidence: 99%

“…The posterior group is connected closely with seminal glands and gives fibers to ductus deferens and ejaculatory duct. The lateral group gives fibers to the prostate reaching its apex and external urethral sphincter [ 14 , 17 , 34 , 44 , 46 , 51 , 53 , 59 ].…”

Section: Autonomic Nervous Systemmentioning

confidence: 99%

“…One of the conclusions was that the pudendal nerve was both somatic and autonomic, located below the levator ani muscle, as opposed to the general thought that the pudendal nerve is purely somatic [ 16 ]. All somatic nerves are accompanied by postsynaptic sympathetic fibers from the lumbar and sacral sympathetic chain to supply the smooth muscles of the blood vessels, sweat glands and apocrine glands, andarrector pili muscle of hair follicle of the skin, and also the bone marrow (which modulates the immune system) of the corresponding regions [ 34 , 62 , 63 , 64 ].…”

Section: Somatic Nervous Systemmentioning

confidence: 99%

“…They are also responsible for complex sexual activity involving genital arousal, orgasm, and ejaculation [ 65 ]. Sympathetic pelvic nerves are involved in the mediation of proprioceptive sensation [ 34 , 66 ] as well as pain [ 36 ] from the upper pelvis via the HN and the SHP to the sympathetic trunk [ 20 ]. Efferent sympathetic nerve fibers evoke contraction of the internal urethral and anal sphincters and exert relaxation on the visceral nonsphincter smooth muscle.…”

Section: Functional Involvement Of Pelvic Nerves In Defecation Micturition Sexual Activity and Pelvic Painmentioning

confidence: 99%

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Review: Pelvic nerves – from anatomy and physiology to clinical applications

Alkatout

Wedel

Pape

et al. 2021

Translational Neuroscience

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A prerequisite for nerve-sparing pelvic surgery is a thorough understanding of the topographic anatomy of the fine and intricate pelvic nerve networks, and their connections to the central nervous system. Insights into the functions of pelvic nerves will help to interpret disease symptoms correctly and improve treatment. In this article, we review the anatomy and physiology of autonomic pelvic nerves, including their topography and putative functions. The aim is to achieve a better understanding of the mechanisms of pelvic pain and functional disorders, as well as improve their diagnosis and treatment. The information will also serve as a basis for counseling patients with chronic illnesses. A profound understanding of pelvic neuroanatomy will permit complex surgery in the pelvis without relevant nerve injury.

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Nerve‐Sparing Gynecologic Surgery Enabled by A Near‐Infrared Nerve‐Specific Fluorophore Using Existing Clinical Fluorescence Imaging Systems

Barth

Rizvi

Masillati

et al. 2023

Small

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Patients undergoing gynecological procedures suffer from lasting side effects due to intraoperative nerve damage. Small, delicate nerves with complex and nonuniform branching patterns in the female pelvic neuroanatomy make nerve‐sparing efforts during standard gynecological procedures such as hysterectomy, cystectomy, and colorectal cancer resection difficult, and thus many patients are left with incontinence and sexual dysfunction. Herein, a near‐infrared (NIR) fluorescent nerve‐specific contrast agent, LGW08‐35, that is spectrally compatible with clinical fluorescence guided surgery (FGS) systems is formulated and characterized for rapid implementation for nerve‐sparing gynecologic surgeries. The toxicology, pharmacokinetics (PK), and pharmacodynamics (PD) of micelle formulated LGW08‐35 are examined, enabling the determination of the optimal imaging doses and time points, blood and tissue uptake parameters, and maximum tolerated dose (MTD). Application of the formulated fluorophore to imaging of female rat and swine pelvic neuroanatomy validates the continued clinical translation and use for real‐time identification of important nerves such as the femoral, sciatic, lumbar, iliac, and hypogastric nerves. Further development of LGW08‐35 for clinical use will unlock a valuable tool for surgeons in direct visualization of important nerves and contribute to the ongoing characterization of the female pelvic neuroanatomy to eliminate the debilitating side effects of nerve damage during gynecological procedures.

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Laparoscopic evaluation of female pelvic neuroanatomy and autonomic plexuses in terms of gynecologic perspective

Cited by 5 publications

References 39 publications

Robot‐assisted laparoscopic management of a vascular entrapment of the sacral nerve roots causing pelvic pain

Robot‐assisted laparoscopic management of a vascular entrapment of the sacral nerve roots causing pelvic pain

Review: Pelvic nerves – from anatomy and physiology to clinical applications

Nerve‐Sparing Gynecologic Surgery Enabled by A Near‐Infrared Nerve‐Specific Fluorophore Using Existing Clinical Fluorescence Imaging Systems

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