Nerve injury during uterosacral ligament fixation: a cadaver study.
OBJECTIVE
The objective of this study was to identify nerve(s) vulnerable to entrapment during uterosacral ligament fixation (USLF), which could cause postoperative lower extremity pain previously described in the literature.


METHODS
Preserved cadavers in a medical anatomy course were used. Before the students' pelvic dissections, a 2-0 prolene suture was placed in the middle third of each left uterosacral ligament visualized. The sutures were re-evaluated at the end of the course.


RESULTS
Nine sutures remained in place after the course, and one entrapped a nerve. It was part of the inferior hypogastric plexus, included fibers from S2 and S3, and radiated to the bladder and rectum. The posterior femoral cutaneous nerve was lateral and posterior to this nerve.


CONCLUSIONS
The inferior hypogastric plexus is vulnerable during USLF. Entrapment of S2 and S3 fibers could cause pain in their respective dermatomes and could be responsible for the postoperative pain previously described.
Collins
Sarah A
SA
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, New York, NY, USA. sarah_collins3@hotmail.com
Downie
Sherry A
SA
Olson
Todd R
TR
Mikhail
Magdy S
MS
D000290:Adnexa Uteri / Q000601:surgery*; D002102:Cadaver; D005260:Female; D006801:Humans; D007001:Hypogastric Plexus / Q000293:injuries*; D008022:Ligaments / Q000601:surgery*; D009408:Nerve Compression Syndromes / Q000209:etiology; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D059348:Peripheral Nerve Injuries / Q000209:etiology*; D011183:Postoperative Complications / Q000209:etiology*; D013537:Sutures / Q000009:adverse effects