ANATOMICAL STUDY OF THE SUPERIOR HYPOGASTRIC PLEXUS FOR THE NERVESPARING SURGICAL PROCEDURES IN FEMALE PELVIS

Abstract

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Background. Para-aortic and presacral lymphadenectomy is frequently performed in the surgical procedures of various gynecologic pelvic malignancies. Postoperative complications such as urinary, anorectal, and sexual dysfunction related to the injury of the superior hypogastric plexus (SHP) during lymphadenectomy have been reported. Aim. The aim of this study was to document the frequency and positional variability of the SHP through gross dissection of fresh cadavers. Material and Methods. Seven female cadavers were transected superior to the origin of the celiac trunk to prevent the SHP from pulling down with overlying peritoneum. The peritoneum in the lumbopelvic region was carefully removed to expose the SHP. A microscope with X2.5 magnification lenses was used during dissections. The degree of deviation and appearance of the SHP were observed and the distances of origin from aortic bifurcation and length with maximal width of the SHP were measured. Results and Discussion. The plexiform-like SHP was found more frequently than single-cord appearance. The SHP extended from the level of intervertebral disc between L4 and L5 below the aortic bifurcation through the sacral promontory in the lesser pelvis. The measurements of the SHP documented in this study are expected to be available in nerve-sparing gynecologic surgeries with minimal complications.