Gynecologic Oncology

Biography

Biography: Vincent Balaya

Abstract

Objectives: By using 3D reconstruction, to provide key-points of surgical neuroanatomy of the female pelvis to improve nerve-sparing radical hysterectomy. Method: Computer-assisted anatomical dissection of three human female pelvis fetus of 12,15 and 24 weeks of gestation, a classic dissection of a 88-years-old woman and a review of the surgical literature up to 2014 on Medline. Results: The Superior Hypogastric Plexus (SHP) divides underneath the promontory into two Hypogastric Nerves (HN). HN descend along the lateral side of the rectum, then run postero-medially to the ureter and in the lateral part of the uterosacral ligament until the superior angle of the Inferior Hypogastric Plexus (IHP). Pelvic Splanchnic Nerves (PSN) emerge from ventral rami of S2, S3 and S4 and run on the postero lateral side of the rectum until the posterior edge of the IHP. IHP extend from the anterolateral face of the rectum and passes lateral to the cervix and the vaginal fornix. Efferences of the IHP are constituted by vesical, vagino-rectal and inferior rectal plexus. Discussion: Preservation of SHP necessitates an approach on the right side of the aorta and a blunt dissection of the promontory before lomboaortic lymphadenectomy. To preserve HN only the medial fibrous part of the uterosacral ligament should be resected. The middle rectal artery, the deep uterine vein and the ureter should be identified to preserve PSN and IHP during resection of paracervix. Vesical branches can be preserved by blunt dissection of the posterior layer of the vesico-uterine ligament after identifying the inferior vesical vein.