Surgical Pelvic Neuroanatomy: An Overview of Commonly Encountered Nerves in Benign Gynecologic Surgeries and Safe Dissection Techniques

Abstract

Video Objective A thorough understanding of the natural course and functions of the nerves in the pelvis is critical in complex benign gynecological surgery to avoid injury and morbidity to the patient. This video reviews how to locate and safely dissect common nerves found in the pelvis that may be encountered in complex gynecological cases. Setting Multiple patients at a large academic center with a robust team of minimally invasive gynecologic surgeons. Many patients have extensive adhesions or severe endometriosis. Interventions Multiple nerves, such as the superior hypogastric plexus, hypogastric nerves, pelvic splanchnic nerves, sacral nerve roots, and the genitofemoral nerves, are dissected out during the course of the surgery. Simple surgical techniques, such as traction-countertraction and blunt dissection are employed. Conclusion In complex gynecologic surgeries, the disease process may require extensive dissections in to the retroperitoneal spaces, where critical pelvic nerves are at risk for injury. With increased knowledge of the natural course of the nerves as well as having an array of dissection techniques, the surgeon can decrease the risk of inadvertent nerve injury and patient morbidity. If the disease is severely involved in areas where fragile nerves are, consideration needs to be given for a nerve preservation.