Pelvic Neuroanatomy Learning from Fresh Frozen Cadaveric Dissections: Overview of Commonly Encountered Pelvic Nerves in Neuropelveology

Abstract

<h3>Study Objective</h3> To describe commonly encountered pelvic nerves and anatomical landmarks in neuropelveologic surgery. <h3>Design</h3> A narrated video explanation of the autonomic nerves and the somatic nerves in the pelvis, their origin, sensory and motor function. <h3>Setting</h3> An anatomic theater for cadaveric dissections and an urban general hospital for in vivo laparoscopy. <h3>Patients or Participants</h3> N/A. <h3>Interventions</h3> Neuropelveology is new groundbreaking discipline in medicine established by Prof. Marc Possover. Neuropelveology is concerned with the diagnosis of injuries and dysfunctions of the pelvic nerves and with the treatment of the symptoms and diseases caused by them. Sparing the pelvic nerves during surgery requires surgical expertise and an immense understanding of pelvic neuroanatomy. In this video, we educationally reviewed with laparoscopic viewpoint pictures of the superior and inferior hypogastric plexus, hypogastric nerves, pelvic splanchnic nerves, sacral splanchnic nerves, femoral nerve, genitofemoral nerve, obturator nerve, lumbosacral trunk, sacral nerve roots (plexus), pudendal nerve (plexus), sciatic nerve, posterior cutaneous nerve of the thigh. Considering the anatomical relationships between these nerves and adjacent structures, we identified the external and iliac vessels, gluteal vessels, internal pudendal vessels, uterine artery, middle rectal artery, ureter, levator ani muscles, coccygeal muscle, piriform muscle, obturator internus muscle, sacrospinous ligament, sacrotuberous ligament, Alcock's canal, ischial rectal (anal) fossa, lesser sciatic foramen, greater sciatic notch, as well as other anatomical structures in the region of those mentioned. <h3>Measurements and Main Results</h3> Cadaveric laparoscopic dissection provided excellent visual information on essential pelvic neural pathways. <h3>Conclusion</h3> The fresh frozen cadaveric dissections are essential tool for acquiring the knowledge of pelvic anatomy, especially the nerve system. The most important nerves groups are the hypogastric plexus and the sympathetic trunk for the autonomic nerve system, and the sacral and the lumbar plexuses for the somatic nerve system. Preservation of the pelvic neural pathways is necessary to deliver the best patient outcomes while minimizing unwanted surgical complications.