title: [Anatomical consideration for the technique of nerve-sparing during radical hysterectomy for cervical cancer].
abstract: Radical hysterectomy (RH) is an effective treatment for early-stage cervical cancer IA2 to IIA1 but RH is often associated with several significant complications such as urinary, anorectal and sexual dysfunction due to pelvic nerve injuries. Pelvic autonomic nerves including the superior hypogastric plexus (SHP), hypogastric nerves (HN), pelvic splanchnic nerves (PSN), sacral splanchnic nerves (SSN), inferior hypogastric plexus (IHP) and efferent branches of the IHP. We aimed to precise the neuroanatomy of the female pelvis in order to provide key-points of surgical anatomy to improve NSRH for cervical cancer. The SHP could be injured during periaortic lymph node dissection and its preservation necessitates an approach on the right side of the aorta and a blunt dissection of the promontory before lomboaortic lymphadenectomy. Injuries to HN can occur during the resection of USL at the posterior pelvic wall and of rectovaginal ligaments and to preserve HN only the medial fibrous 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. Vesical branches can be preserved by blunt dissection of the posterior layer of the vesicouterine ligament after identifying the inferior vesical vein. In most of cases, NSRH for cervical cancer can be performed. Anatomical landmarks as middle rectal artery, deep uterine vein, inferior vesical vein and ureter and the respect of nervous part of uterine ligament and of parametrium provide to surgeon a safe preservation of pelvic innervation without compromising oncological outcomes.
authors: Service de chirurgie cancérologique, gynécologique et du sein, hôpital européen Georges-Pompidou (HEGP), 20, rue Leblanc, 75908 Paris cedex 15, France; URDIA anatomie, UFR biomédicale des Saints-Pères, 45, rue des Saints-Pères, 75006 Paris, France; Faculté de médecine, université Paris Descartes, 15, rue de l'École-de-Médecine, 75006 Paris, France. Electronic address: vbalaya@hotmail.com.
authors: V
authors: V
authors: Balaya
authors: Service de chirurgie cancérologique, gynécologique et du sein, hôpital européen Georges-Pompidou (HEGP), 20, rue Leblanc, 75908 Paris cedex 15, France; Faculté de médecine, université Paris Descartes, 15, rue de l'École-de-Médecine, 75006 Paris, France.
authors: C
authors: C
authors: Ngo
authors: Service de chirurgie cancérologique, gynécologique et du sein, hôpital européen Georges-Pompidou (HEGP), 20, rue Leblanc, 75908 Paris cedex 15, France; Faculté de médecine, université Paris Descartes, 15, rue de l'École-de-Médecine, 75006 Paris, France.
authors: L
authors: L
authors: Rossi
authors: Service de chirurgie cancérologique, gynécologique et du sein, hôpital européen Georges-Pompidou (HEGP), 20, rue Leblanc, 75908 Paris cedex 15, France; Faculté de médecine, université Paris Descartes, 15, rue de l'École-de-Médecine, 75006 Paris, France.
authors: C
authors: C
authors: Cornou
authors: Service de chirurgie cancérologique, gynécologique et du sein, hôpital européen Georges-Pompidou (HEGP), 20, rue Leblanc, 75908 Paris cedex 15, France; Faculté de médecine, université Paris Descartes, 15, rue de l'École-de-Médecine, 75006 Paris, France.
authors: C
authors: C
authors: Bensaid
authors: URDIA anatomie, UFR biomédicale des Saints-Pères, 45, rue des Saints-Pères, 75006 Paris, France; Faculté de médecine, université Paris Descartes, 15, rue de l'École-de-Médecine, 75006 Paris, France; Service de chirurgie digestive, générale et cancérologique, hôpital européen Georges-Pompidou (HEGP), 20, rue Leblanc, 75908 Paris cedex 15, France.
authors: R
authors: R
authors: Douard
authors: Service de chirurgie cancérologique, gynécologique et du sein, hôpital européen Georges-Pompidou (HEGP), 20, rue Leblanc, 75908 Paris cedex 15, France; Faculté de médecine, université Paris Descartes, 15, rue de l'École-de-Médecine, 75006 Paris, France.
authors: A S
authors: AS
authors: Bats
authors: Service de chirurgie cancérologique, gynécologique et du sein, hôpital européen Georges-Pompidou (HEGP), 20, rue Leblanc, 75908 Paris cedex 15, France; Faculté de médecine, université Paris Descartes, 15, rue de l'École-de-Médecine, 75006 Paris, France.
authors: F
authors: F
authors: Lecuru
mesh_terms: D001341:Autonomic Nervous System / Q000293:injuries; D005260:Female; D006801:Humans; D007001:Hypogastric Plexus / Q000293:injuries; D007044:Hysterectomy / Q000379:methods*; D010388:Pelvis / Q000294:innervation*; D059348:Peripheral Nerve Injuries / Q000517:prevention & control*; D013153:Splanchnic Nerves / Q000293:injuries; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000601:surgery*; D014599:Uterus / Q000098:blood supply / Q000294:innervation
keywords: Anatomie pelvienne féminine; Cancer du col; Cervical cancer; Hystérectomie radicale; Inferior hypogastric plexus; Nerve-sparing; Pelvic female anatomy; Plexus hypogastrique inférieur; Radical hysterectomy