Relationships Between Pelvic Nerves and Levator Ani Muscle for Posterior Sacrocolpopexy: an Anatomic Study

Overview

Journal Surg Radiol Anat

Specialties Anatomy & Histology
General Surgery
Radiology

Date 2022 May 23

PMID 35604460

Authors

Gregoire Rocher

Henri Azais

Amelia Favier

Catherine Uzan

Mathieu Castela

Gaby Moawad

Vincent Lavoue

Xavier Morandi

Krystel Nyangoh Timoh

Geoffroy Canlorbe

Affiliations

Soon will be listed here.

Abstract

Background: The placement of posterior mesh during pelvic organ prolapse laparoscopic surgery has been incriminated as responsible for postoperative adverse outcomes such as digestive symptoms, chronic pelvic pain, and sexual dysfunction. These complications may be related to neural injuries that occur during the fixation of the posterior mesh on the levator ani muscle.

Objectives: The aim of our study was to describe the course of the autonomic nerves of the pararectal space and their anatomical relationship with the posterior mesh fixation zone on the levator ani muscle.

Study Design: Twenty hemi-pelvis specimens from 10 fresh female cadavers were dissected. We measured the distance between the posterior mesh fixation zone on the levator ani, and the nearest point of adjacent structures: the hypogastric nerve, inferior hypogastric plexus, uterosacral ligament, uterine artery, and ureter. Measurements were repeated starting from the inferior hypogastric plexus.

Results: Nerve fibers of the inferior hypogastric plexus spread out systematically above the superior aspect of the levator ani muscle. Median distance from the posterior mesh fixation zone and the inferior hypogastric plexus was around 2.8 (range 2.1-3.5) cm.

Conclusions: The inferior hypogastric plexus lies above the superior aspect of the levator ani muscle. A short distance between the posterior mesh fixation zone on the levator ani muscle and inferior hypogastric plexus could explain in part postoperative digestive symptoms. These observations support the development of nerve-sparing procedures for posterior mesh placement in the context of pelvic organ prolapse repair and suggest that postoperative complications could be improved by changing the fixation zone.

Citing Articles

Morphological Peculiarities of the Pelvic Autonomic Nervous System and Their Impact on Clinical Interventions in the Lesser Pelvic Region.

Kuruc R, Szoradova A, Kristova J, Solarova M, Sidlo J, Matejcik V Medicina (Kaunas). 2023; 59(1).

PMID: 36676696 PMC: 9861675. DOI: 10.3390/medicina59010072.

References

Acsinte O, Rabischong B, Bourdel N, Canis M, Botchorishvili R . Laparoscopic Promontofixation in 10 Steps. J Minim Invasive Gynecol. 2017; 25(5):767. DOI: 10.1016/j.jmig.2017.10.020. View

Allen R, Hosker G, Smith A, WARRELL D . Pelvic floor damage and childbirth: a neurophysiological study. Br J Obstet Gynaecol. 1990; 97(9):770-9. DOI: 10.1111/j.1471-0528.1990.tb02570.x. View

Baader B, Herrmann M . Topography of the pelvic autonomic nervous system and its potential impact on surgical intervention in the pelvis. Clin Anat. 2003; 16(2):119-30. DOI: 10.1002/ca.10105. View

Balaya V, Ngo C, Rossi L, Cornou C, Bensaid C, Douard R . [Anatomical consideration for the technique of nerve-sparing during radical hysterectomy for cervical cancer]. Gynecol Obstet Fertil. 2016; 44(9):517-25. DOI: 10.1016/j.gyobfe.2016.07.009. View

Borgmann H, Rodriguez Socarras M, Salem J, Tsaur I, Gomez Rivas J, Barret E . Feasibility and safety of augmented reality-assisted urological surgery using smartglass. World J Urol. 2016; 35(6):967-972. DOI: 10.1007/s00345-016-1956-6. View

Bui C, Ballester M, Chereau E, Guillo E, Darai E . [Functional results and quality of life of laparoscopic promontofixation in the cure of genital prolapse]. Gynecol Obstet Fertil. 2010; 38(10):563-8. DOI: 10.1016/j.gyobfe.2010.06.001. View

Ceccaroni M, Clarizia R, Roviglione G, Ruffo G . Neuro-anatomy of the posterior parametrium and surgical considerations for a nerve-sparing approach in radical pelvic surgery. Surg Endosc. 2013; 27(11):4386-94. DOI: 10.1007/s00464-013-3043-z. View

Chong G, Lee Y, Hong D, Cho Y, Park I, Lee Y . Robot versus laparoscopic nerve-sparing radical hysterectomy for cervical cancer: a comparison of the intraoperative and perioperative results of a single surgeon's initial experience. Int J Gynecol Cancer. 2013; 23(6):1145-9. DOI: 10.1097/IGC.0b013e31829a5db0. View

Christmann-Schmid C, Koerting I, Ruess E, Faehnle I, Krebs J . Functional outcome after laparoscopic nerve-sparing sacrocolpopexy: a prospective cohort study. Acta Obstet Gynecol Scand. 2018; 97(6):744-750. DOI: 10.1111/aogs.13337. View

10.

Coolen A, van IJsselmuiden M, van Oudheusden A, Veen J, van Eijndhoven H, Mol B . Laparoscopic sacrocolpopexy versus vaginal sacrospinous fixation for vaginal vault prolapse, a randomized controlled trial: SALTO-2 trial, study protocol. BMC Womens Health. 2017; 17(1):52. PMC: 5530566. DOI: 10.1186/s12905-017-0402-2. View

11.

Cosma S, Petruzzelli P, Danese S, Benedetto C . Nerve preserving standard laparoscopic sacropexy: Postoperative bowel function. World J Gastrointest Endosc. 2017; 9(5):211-219. PMC: 5437387. DOI: 10.4253/wjge.v9.i5.211. View

12.

DeLancey J . What's new in the functional anatomy of pelvic organ prolapse?. Curr Opin Obstet Gynecol. 2016; 28(5):420-9. PMC: 5347042. DOI: 10.1097/GCO.0000000000000312. View

13.

DeLancey J, Morgan D, Fenner D, Kearney R, Guire K, Miller J . Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse. Obstet Gynecol. 2007; 109(2 Pt 1):295-302. DOI: 10.1097/01.AOG.0000250901.57095.ba. View

14.

Ercoli A, Campagna G, Delmas V, Ferrari S, Morciano A, Scambia G . Anatomical insights into sacrocolpopexy for multicompartment pelvic organ prolapse. Neurourol Urodyn. 2015; 35(7):813-8. DOI: 10.1002/nau.22806. View

15.

Faucheron J . Pelvic anatomy for colorectal surgeons. Acta Chir Belg. 2005; 105(5):471-4. DOI: 10.1080/00015458.2005.11679762. View

16.

Fermaut M, Nyangoh Timoh K, Lebacle C, Moszkowicz D, Benoit G, Bessede T . [Deep infiltrating endometriosis surgical management and pelvic nerves injury]. Gynecol Obstet Fertil. 2016; 44(5):302-8. DOI: 10.1016/j.gyobfe.2016.03.007. View

17.

Gluck O, Blaganje M, Veit-Rubin N, Phillips C, Deprest J, OReilly B . Laparoscopic sacrocolpopexy: A comprehensive literature review on current practice. Eur J Obstet Gynecol Reprod Biol. 2020; 245:94-101. DOI: 10.1016/j.ejogrb.2019.12.029. View

18.

Le Normand L, Cosson M, Cour F, Deffieux X, Donon L, Ferry P . Clinical Practice Guidelines: Synthesis of the guidelines for the surgical treatment of primary pelvic organ prolapse in women by the AFU, CNGOF, SIFUD-PP, SNFCP, and SCGP. J Gynecol Obstet Hum Reprod. 2017; 46(5):387-391. DOI: 10.1016/j.jogoh.2017.05.001. View

19.

Lee R . On the nervous ganglia of the uterus, and an appendix to a paper on the nervous ganglia of the uterus, with a further account of the nervous structures of that organ. Robert Lee. Philosophical Transactions of the Royal Society of London, part I, pp..... Am J Obstet Gynecol. 1978; 131(2):217-8. DOI: 10.1016/0002-9378(78)90668-3. View

20.

Li L, Bi Y, Wang L, Mao X, Kraemer B, Lang J . Identification and injury to the inferior hypogastric plexus in nerve-sparing radical hysterectomy. Sci Rep. 2019; 9(1):13260. PMC: 6744562. DOI: 10.1038/s41598-019-49856-w. View