Fondazione IRCCS National Cancer Institute of Milan (Ditto, Ferla, Martinelli, Bogani, Maggiore, and Raspagliesi), Milan, Italy.
Fondazione IRCCS National Cancer Institute of Milan (Ditto, Ferla, Martinelli, Bogani, Maggiore, and Raspagliesi), Milan, Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna (Ferla), Bologna, Italy.
J Minim Invasive Gynecol. 2024 Oct;31(10):821-822. doi: 10.1016/j.jmig.2024.04.014. Epub 2024 Apr 19.
During radical pelvic surgeries fibers of the autonomic pelvic nervous network can be accidentally damaged leading to significant visceral sequelae, which dramatically affect women's quality of life because of urinary, anorectal, and sexual postoperative dysfunctions. Direct visualization is one way to preserve hypogastric nerves (HNs), pelvic splanchnic nerves (PSNs), and the bladder branches from the inferior hypogastric plexus (IHP). However, the literature lacks critical photos and/or illustrations that are necessary to understand the precise anatomy needed to preserve the pelvic autonomic fibers.
Narrated laparoscopic video footage for identifying, dissecting, and preserving the autonomic nerve bundles during pelvic surgery.
Tertiary level hospital-"IRCCS Istituto Nazionale dei Tumori", Milano, Italy.
Visceral pelvic innervation is established by the superior hypogastric plexus(SHP) located anteriorly to the aortic bifurcation and the median sacral vessels and carries mostly sympathetic fibers. SHP divides in front of the sacrum into the right and left HN. At the level of the paracervix, the HNs join the parasympathetic PSNs coming out from sacral root S2, S3, S4 to form the IHP. Here, we performed laparoscopic surgery, before "Laparoscopic Approach to Cervical Cancer" trial (LACC) era, identifying key anatomic landmarks useful to highlight the path of the most commonly encountered autonomic pelvic nerves in gynecologic radical surgery: during the narration we describe and illustrate the procedure to identify all autonomic pelvic nerves, the sympathetic fibers, the PSNs, and the bladder branch emerging from the IHP in order to preserve their anatomic and functional integrity. This technique is anatomically and surgically indicated for adequate removal of the parametrical issues and vagina while preserving the total pelvic nervous system.
Nerve-sparing surgery reduces bowel-, bladder- and sexual- dysfunction without decreasing surgical efficacy. To accomplish safe and effective surgery, comprehension of the 3 dimensional structure of the vascular and nerve anatomy in the pelvis is essential. This video provides a great resource to educate surgeons, especially the youngest ones, about the retroperitoneal nervous networking: we identified the autonomic nerve pathway from adjacent tissues along the pathway consisting of cardinal, sacro-uterine, rectouterine/vaginal, and vesico-uterine ligaments.
在根治性盆腔手术中，自主盆腔神经网络的纤维可能会意外受损，导致明显的内脏后遗症，这极大地影响了女性的生活质量，因为术后会出现尿、肛肠和性功能障碍。直接可视化是保留腹下神经（HNs）、盆腔内脏神经（PSNs）和来自下腹部下丛（IHP）的膀胱分支的一种方法。然而，文献中缺乏关键的照片和/或插图，这些都是理解保留盆腔自主纤维所需的精确解剖所必需的。
用于识别、解剖和保留盆腔手术中自主神经束的叙述性腹腔镜视频片段。
意大利米兰的三级医院——IRCCS 国家肿瘤研究所（Istituto Nazionale dei Tumori）。
内脏盆腔神经支配由位于主动脉分叉和正中骶血管前方的上腹下丛（SHP）建立，主要携带交感纤维。SHP 在骶骨前方分为左右 HN。在子宫旁水平，HN 与发自 S2、S3、S4 骶神经根的副交感 PSNs 结合，形成 IHP。在这里，我们在“腹腔镜宫颈癌前哨淋巴结活检”（LACC）时代之前进行了腹腔镜手术，确定了关键的解剖标志，这些标志有助于突出妇科根治性手术中最常见的自主盆腔神经的路径：在叙述过程中，我们描述并说明了识别所有自主盆腔神经、交感纤维、PSNs 和从 IHP 发出的膀胱分支的过程，以保持其解剖和功能的完整性。这种技术在解剖学和手术上适用于充分切除参数问题和阴道，同时保留整个盆腔神经系统。
神经保留手术减少了肠道、膀胱和性功能障碍，而不会降低手术疗效。为了实现安全有效的手术，必须理解骨盆中血管和神经解剖的三维结构。该视频为教育外科医生，特别是年轻医生提供了一个很好的资源，了解腹膜后神经网络：我们从相邻组织中识别自主神经通路，沿着包括子宫旁、骶子宫、直肠子宫/阴道和膀胱子宫韧带的路径。
