Laparoscopic pelvic anatomy of nerve‐sparing radical hysterectomy

Abstract

Many reports regarding nerve-sparing radical hysterectomy have been published. However, most reports have been based on systematic descriptions via laparotomy or cadaver dissection. The aim of this work was to describe the pelvic anatomy of nerve-sparing radical hysterectomy via laparoscopy, with specific focus on the inferior hypogastric plexus. This study is based on 125 patients with FIGO stage IB cervical cancer who had undergone laparoscopic nerve-sparing radical hysterectomies since 1999. The inferior hypogastric plexus was demonstrated via laparoscopy and was comprised of afferent fibers from the sacral root (S2, S3, and S4), sacral sympathetic ganglion, and hypogastric nerve, and efferent fibers forming its vesical, uterovaginal, and rectal branches. During the dissection of the posterior leaf of the vesicouterine ligament, various vesical veins were identified. If the cut edge of an inferior vesical vein was pulled medially with upward traction, the vesical branches of the inferior hypogastric plexus were exposed and these were divided into medial and lateral branches. The magnified view of laparoscopy made it possible to dissect nerves and vessels meticulously and to secure a clear resection margin during the dissection of the deep part of the cardinal ligament, uterosacral ligament, and posterior leaf of the vesicouterine ligament.

Effect of Laparoscopic Nerve-sparing Radical Hysterectomy on Bladder Function, Intestinal Function Recovery and Quality of Sexual Life in Patients with Cervical Carcinoma

“…Present data have indicated that NSRH does not extend the risk of surgery approaches and perioperative surveillance. Depending on our data and other scholars' achievements, (Sakuragi et al, 2005;Papp et al, 2006;Park et al, 2010).…”

Proteomic Analysis of Pelvic Autonomic Nerve in Nerve-sparing Radical Hysterectomy for Cervical Carcinoma

“…Our operative technique and concept of NSRH have been described in detail elsewhere (5). The study was approved by the Institutional Review Board (approval number: KNUMC 14-1064) and performed with informed consents.…”

Laparoscopic implantation of neural electrodes on pelvic nerves: an experimental study on the obturator nerve in a chronic minipig model

“…The availability of better optical systems and the advantage of augmented vision have facilitated unprecedented advances in operative methodology [1]. Laparoscopy allows surgeons to visualize small structures in detail, perform meticulous coagulation, and access deeper spaces, thus achieving amazing dissection levels [2,3]. In addition, these advantages are accompanied by the possibility of performing more precise surgical maneuvers, thus minimizing damage to surrounding tissues in areas where access is difficult.…”

“…Today, the feasibility of exposing the main somatic and autonomic nerves in the pelvis is well documented [2,3]. In addition, from the ability to preserve autonomic innervation of pelvic organs the so-called ''nerve-sparing'' techniques have developed [6][7][8][9], with growing popularity in surgical oncology [8][9][10][11] and deep endometriosis surgery [12,13].…”

“…This is especially true in the surgical approach to the pelvic retroperitoneum [3][4][5]. As a result of the advent of this new vision of anatomy, laparoscopic surgeons have had to deepen their knowledge of anatomy beyond the classic references of conventional surgical anatomy [1][2][3][4][5][6]. Consequently, this ''laparoscopic anatomy'' has led to changing concepts, from ''surgical anatomy'' to ''anatomical surgery'' [3,4].…”