Three-Dimensional Modelization of the Female Human Inferior Hypogastric Plexus: Implications for Nerve-Sparing Radical Hysterectomy

2018 ◽  
Vol 84 (2) ◽  
pp. 196-203 ◽  
Author(s):  
Vincent Balaya ◽  
Fabien Guimiot ◽  
Jean-François Uhl ◽  
Charlotte Ngo ◽  
Myriam Delomenie ◽  
...  
Keyword(s):  
Radical Hysterectomy ◽  
Three Dimensional ◽  
Nerve Sparing ◽  
Inferior Hypogastric Plexus ◽  
Hypogastric Plexus

Nerve-sparing radical hysterectomy: steps to standardize surgical technique

2019 ◽  
Vol 29 (7) ◽  
pp. 1203-1208 ◽  
Author(s):  
Mustafa Zelal Muallem ◽  
Yasser Diab ◽  
Jalid Sehouli ◽  
Shingo Fujii
Keyword(s):  
Radical Hysterectomy ◽  
Splanchnic Nerve ◽  
Primary Objective ◽  
Autonomic Nerve ◽  
Surgical Approaches ◽  
Nerve Sparing ◽  
Inferior Hypogastric Plexus ◽  
Splanchnic Nerves ◽  
Hypogastric Plexus ◽  
Pelvic Splanchnic Nerves

AimThe primary objective of this review was to study and analyze techniques of nerve-sparing radical hysterectomy so as to be able to characterize and elucidate intricate steps for the dissection of each component of the pelvic autonomic nerve plexuses during nerve-sparing radical hysterectomy.MethodsThis review was based on a five-step study design that included searching for relevant publications, selecting publications by applying inclusion and exclusion criteria, quality assessment of the identified studies, data extraction, and data synthesis.ResultsThere are numerous differences in the published literature concerning nerve-sparing radical hysterectomy including variations in techniques and surgical approaches. Techniques that claim to be nerve-sparing by staying above the dissection level of the hypogastric nerves do not highlight the pelvic splanchnic nerve, do not take into account the intra-operative patient position, nor the fact that the bladder branches leave the inferior hypogastric plexus in a ventrocranial direction, and the fact that inferior hypogastric plexus will be drawn cranially with the vaginal walls (if this is not recognized and isolated earlier) above the level of hypogastric nerves by drawing the uterus cranially during the operation.ConclusionsThe optimal nerve-sparing radical hysterectomy technique has to be radical (type C1) and must describe surgical steps to highlight all three components of the pelvic autonomic nervous system (hypogastric nerves, pelvic splanchnic nerves, and the bladder branches of the inferior hypogastric plexus). Recognizing the pelvic splanchnic nerves in the caudal parametrium and the isolation of the bladder branches of the inferior hypogastic plexus requires meticulous preparation of the caudal part of the ventral parametrium.

scholarly journals Identification and injury to the inferior hypogastric plexus in nerve-sparing radical hysterectomy

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Lei Li ◽  
Yalan Bi ◽  
Leiming Wang ◽  
Xinxin Mao ◽  
Bernhard Kraemer ◽  
...  
Keyword(s):  
Radical Hysterectomy ◽  
Immunohistochemical Staining ◽  
Lower Percentage ◽  
Controlled Study ◽  
Control Group ◽  
Nerve Sparing ◽  
Inferior Hypogastric Plexus ◽  
Hypogastric Plexus ◽  
Neural Tissues ◽  
Waterjet Dissection

Abstract Waterjet dissection of the inferior hypogastric plexus (IHP) resulted in a more rapid return of normal urodynamics than blunt dissection (control group) in patients who received laparoscopic nerve-sparing radical hysterectomy (NSRH) in a randomized controlled study. However, the definite reasons for these results were unknown. This subgroup analysis compared the neural areas and impairment in the IHP uterine branches harvested during NSRH as an alternative to the IHP vesical branches between the waterjet and control groups. This study included samples from 30 eligible patients in each group of the trial NCT03020238. At least one specimen from each side of the IHP uterine branches was resected. The tissues were scanned, images were captured, and the neural component areas were calculated using the image segmentation method. Immunohistochemical staining was used to evaluate neural impairment. The control and waterjet groups had similar areas of whole tissues sent for evaluation. However, the control group had significantly fewer areas (median 272158 versus 200439 μm2, p = 0.044) and a lower percentage (median 4.9% versus 3.0%, p = 0.011) of neural tissues. No significant changes in immunohistochemical staining were found between the two groups. For patients with residual urine ≤100 and >100 ml at 14 days after NSRH (42 and 18 patients, respectively), there were significantly different percentages of neural tissues in the resected samples (p < 0.001). Hence, Due to the accurate identification of IHP during NSRH, the waterjet dissection technique achieved better urodynamic results.

Nerve-sparing radical hysterectomy in patients with infiltrative cervical cancer

2016 ◽  
pp. 46-51
Author(s):  
T. Dermenzhy ◽  
◽  
V. Svintitskiy ◽  
S. Nespryadko ◽  
L. Legerda ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radical Hysterectomy ◽  
Contractile Function ◽  
Major Elements ◽  
Control Group ◽  
Nerve Sparing ◽  
Group I ◽  
Hypogastric Plexus ◽  
Prognostic Indexes

The objective: to improve an effectiveness of therapy and quality of life of patients with infiltrative cervical cancer using radical hysterectomy accomplished with nerve-sparing methodology. Patients and Methods: Ninety patients with histologically verified infiltrative cervical cancer were cured with radical hysterectomy (RHE) in the Department of Oncogynecology of National Cancer Institute (Kyiv, Ukraine) in 2012-2016. The age of the patients was from 26 to 65 years (an average age of 42.61±1.06). The patients were distributed in 2 groups: group I treated with nerve-sparing radical hysterectomy (NSRHE), 45 patients, the main group; group II treated with radical hysterectomy (RHE III), the control group, 45 patients. The prognostic indexes in the groups were similar. Results. NSRHE that included the dissection of cardinal ligament, separation of dorsal and anterior layers of uterovesical ligament allowed separate uterine branch of inferior hypogastric plexus, preserve an innervation of urinary bladder and prevent the malfunction of its contractile function at postoperative period. Conclusion. The data of the urodynamic study using cystomanometry performed at pre- and early operative periods have shown that surgical treatment of patients with infiltrative cervical cancer with preservation of the major elements of pelvic autonomic plexuses allows significantly decrease the rate of postoperative urogenical malfunctions. Key words: nerve-sparing radical hysterectomy, cervical cancer, cystomanometry.

scholarly journals A Concise Paradigm on Radical Hysterectomy: The Comprehensive Anatomy of Parametrium, Paracolpium and the Pelvic Autonomic Nerve System and Its Surgical Implication

Cancers ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 1839 ◽  
Author(s):  
Mustafa Zelal Muallem ◽  
Thomas Jöns ◽  
Nadja Seidel ◽  
Jalid Sehouli ◽  
Yasser Diab ◽  
...  
Keyword(s):  
Radical Hysterectomy ◽  
Three Dimensional ◽  
Figo Stage ◽  
Autonomic Nerve ◽  
Nerve Sparing ◽  
Anatomical Structures ◽  
Pelvic Autonomic Nerve ◽  
Direct Infiltration ◽  
Autonomic Nerve System ◽  
Nerve System

The current understanding of radical hysterectomy is more centered on the uterus and little is discussed regarding the resection of the vaginal cuff and the paracolpium as an essential part of this procedure. The anatomic dissections of two fresh and 17 formalin-fixed female pelvis cadavers were utilized to understand and decipher the anatomy of the pelvic autonomic nerve system (PANS) and its connections to the surrounding anatomical structures, especially the paracolpium. The study mandates the recognition of the three-dimensional (3D) anatomic template of the parametrium and paracolpium and provides herewith an enhanced scope during a nerve-sparing radical hysterectomy procedure by precise description of the paracolpium and its close anatomical relationships to the components of the PANS. This enables the medical fraternity to distinguish between direct infiltration of the paracolpium, where the nerve sparing technique is no longer possible, and the affected lymph node in the paracolpium, where nerve sparing is still an option. This study gives rise to a tailored surgical option that allows for abandoning the resection of the paracolpium by FIGO stage IB1, where less than 2 cm vaginal vault resection is demanded.

Le basi anatomiche della prevenzione dei danni neurogeni in corso di chirurgia radicale pelvica nella donna

1994 ◽  
Vol 61 (1_suppl) ◽  
pp. 160-161
Author(s):  
B. Frea ◽  
E. Kocjancic ◽  
R. Musci ◽  
T. Meroni
Keyword(s):  
Adult Female ◽  
Pelvic Surgery ◽  
Nerve Sparing ◽  
Pelvic Cavity ◽  
Pelvic Plexus ◽  
Inferior Hypogastric Plexus ◽  
Hypogastric Plexus

Radical pelvic surgery in women is considerably handicapped by serious neurogenic complications, commonly due to lesions in the inferior hypogastric plexus or its branches, which cannot be easily identified in the female pelvic cavity. The pelvic cavities of 42 adult female cadavers were studied and the relations between the nervous structures and the cardinal and utero-sacral ligaments were analysed. The possibility of identifying and recognising in vivo anatomical findings of the pelvic plexus is the fulcrum of nerve sparing pelvic surgery.

scholarly journals The anatomy of the male inferior hypogastric plexus: What should we know for nerve sparing surgery

2018 ◽  
Vol 31 (6) ◽  
pp. 788-796 ◽  
Author(s):  
Raphael Röthlisberger ◽  
Valerie Aurore ◽  
Susanne Boemke ◽  
Hannes Bangerter ◽  
Mathias Bergmann ◽  
...  
Keyword(s):  
Nerve Sparing ◽  
Inferior Hypogastric Plexus ◽  
Hypogastric Plexus

scholarly journals Nerve-Sparing Radical Hysterectomy Using the Okabayashi–Kobayashi Method

2021 ◽  
Author(s):  
Noriaki Sakuragi ◽  
Masanori Kaneuchi
Keyword(s):  
Radical Hysterectomy ◽  
Early Stage ◽  
Three Dimensional ◽  
Pelvic Lymphadenectomy ◽  
Dimensional Structure ◽  
Nerve Sparing ◽  
Autonomic Nerves ◽  
Clear Understanding ◽  
Intraoperative Bleeding ◽  
Early Stage Cervical Cancer

AbstractRadical hysterectomy (RH) is a standard treatment for early-stage cervical cancer. This surgery extirpates the uterus along with the paracervical tissues, vagina, and the paracolpium to achieve local control. Pelvic lymphadenectomy is a critical component of RH performed for regional control. A clear understanding of pelvic anatomy is critical to safely performing a RH and achieving optimal oncological and functional outcomes. The various surgical steps can damage the pelvic autonomic nerves, and a systematic nerve-sparing technique is used for the preservation of autonomic nerves. There is an intricate vascular network in the lateral paracervix (cardinal ligament) and the pelvic sidewall. We need to comprehend the three-dimensional structure of the vascular and nerve anatomy in the pelvis to perform RH effectively and safely. We can create six spaces around the uterine cervix, including the paravesical spaces, pararectal spaces, a vesicovaginal space, and a rectovaginal space to reveal the target of extirpation. It is critical to find the proper tissue plane separated by the layers of membranous connective tissue (fascia), in order to minimize intraoperative bleeding.

Sign in / Sign up

Export Citation Format

Share Document