Quantitative anatomical study of male pelvic autonomic plexus and its clinical potential in rectal resection

Abstract

The pelvic autonomic nerves innervate the pelvic viscera, and carry a high risk of damage during surgery. This high risk has been ascribed to the complex interrelationship of pelvic paravisceral structures and the difficulty in identifying particular structures, despite the fact that the anatomic characteristics of the pelvic autonomic plexus have been well documented. We dissected ten male embalmed adult cadavers with particular attention to the quantitative parameters of the pelvic plexus and its subsidiary plexus. The right inferior hypogastric plexus and its rectal branch were found to be significantly longer and wider than the left one, while the transverse diameter of the vesical and prostatic branches of the left side was significantly larger the right. The inferior mesenteric plexus gave off fibers directly to form the pelvic plexus in four of 20 hemipelves (20%). In the side-by-side comparison, the distance to midpoint of the sacral promontory of the left rectal plexus was significantly longer than that of the right, whereas the maximum length (the length of the longest nerve fiber from origin to corresponding organ) of the left vesical plexus was significantly shorter than that of the right. Additionally, the craniocaudal and dorsoventral diameters of the right pelvic autonomic plexus were significantly shorter those of the left. The quantitative parameters relating to the pelvic autonomic plexuses not only can enhance our understanding of its anatomy and function, but can also be used as references for surgical procedures and robot-assisted surgery.

Surgeons’ assessment of internal anal sphincter nerve supply during TaTME - inbetween expectations and reality

“…The tiny neurogenic pathways could be visually identified in up to 45% on each pelvic side and were found tracing the pelvic floor in posterolateral (4–5 and 7–8 o’clock lithotomy position) to anterolateral direction on the supralevatoric pelvic sidewall (3 and 9 o’clock lithotomy position) up to the IRP. Cadaver dissection via non-surgical approach demonstrated variations of the branches in terms of number (three to six nerve fibers), diameter (up to 1.1 ± 0.2 mm) and length (up to 37.3 ± 13.6 mm) ( 2 ). Recently, video-endoscopic supported cadaver dissections with a “bottom up” approach revealed them to reach the most distal rectum constituting nerve fibers to the IAS ( 15 ).…”

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

“…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…”

Current status of rectal cancer treatment in China

“…Few papers have been published, owing to the high cost and limited application of the method. A study of 15 patients undergoing rectal operations by robotic surgery showed a similar short‐term outcome with no complications compared with laparoscopic surgery . Meta‐analysis comparing laparoscopic surgery and robotic surgery has demonstrated the latter method to benefit from less blood loss, shorter hospital stay and lower rate of intra‐operative conversion, especially when TME principle was followed .…”