Pelvic nerve injury during radical hysterectomy for cervical cancer: key anatomical zone

Objectives: To precise key-points of surgical neuroanatomy of the female pelvis to improve nerve-sparing radical hysterectomy (RH). Material and Methods: Review of the literature, computer-assisted anatomical dissection, and classic dissection of a female cadaver. Results: The superior hypogastric plexus (SHP) divides into two hypogastric nerves (HN). HN 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-S4 and join the posterior edge of the IHP. IHP passes lateral to the cervix and the vaginal fornix. Conclusions: 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 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.

Cervical cancer; Nerve-sparing; Radical hysterectomy; Pelvic female anatomy; Inferior hypogastric plexus.

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