The anatomy of the pelvic plexus in female cadavers: implications for retroperitoneal nerve-sparing surgery.

ABSTRACT

Background: The inferior hypogastric plexus (IHP) is a crucial structure for female continence and sexual function. A nerve-sparing approach should be pursued to reduce the risk of pelvic plexus damage during retroperitoneal pelvic surgery. Objectives: To analyse the relationship between the female IHP and several pelvic anatomical landmarks. Materials and Methods: Standardised cadaveric dissection was performed on 5 nulliparous female cadavers. The relationships of the IHP and the mid-cervical plane (MCP), the mid-sagittal plane (MSP), and the uterosacral ligament (USL) were investigated. Main outcome measures: Distance between IHP and MCP, MSP, and USL. Results: Distances between the right IHP and the right MSP (mean distance 16.3 mm; range 10.0-22.5 mm) and the right USL (mean distance 4.8 mm; range 0-15.0 mm) were shorter than those between the left IHP and ipsilateral landmarks (left MSP distance 23.5 mm; range 18.0-30.0 mm; left USL distance 5.0 mm; range 0-20.0 mm). Although the MCP was 3.3 mm (range 2.5-4.0 mm) left and lateral to the midsagittal line, the right IHP was closer to the MCP (mean distance 19.6 mm; range 13.0-25.0 mm) than the left one (mean distance 20.2 mm; range 15.0-26.0 mm). Conclusions: Distances between the right IHP and the MSP, MCP, and ipsilateral USL, are shorter compared to these associated to the left IHP. What is new? Right autonomic pelvic plexus is closer to the midline planes and the ipsilateral USL. These anatomical relationships may be greatly helpful for pelvic surgeon while facing retroperitoneal pelvic surgery and looking for a nerve-sparing approach.