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Robotic Rectal Cancer Surgery
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
SP Somashekhar, K Rajagopal Ashwin
The autonomic nerves consist of the paired sympathetic hypogastric nerve, sacral splanchnic nerves, and the pelvic autonomic nerve plexus. The superior hypogastric plexus is located ventrally to the abdominal aorta a t the origin of IMA and later bifurcates to form right and left hypogastric nerves just proximal to at the sacral hollow. The hypogastric nerves, which derive from the superior hypogastric plexus, carry the sympathetic signals to the internal urethral and anal sphincters, as well as to the pelvic visceral proprioception. The pelvic splanchnic nerves from S2 to S4 carry nociceptive and parasympathetic signals to the bladder, rectum, and colon. The hypogastric and pelvic splanchnic nerves merge into the pararectal fossae to form the inferior hypogastric plexus [16].
Peripheral Neuropathies of the Lower Urinary Tract Following Pelvic Surgery and Radiation Therapy
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
The evaluation of lower urinary tract dysfunction in a patient at risk from peripheral neuropathy begins with a heightened level of suspicion by the provider. The inferior hypogastric plexus, in particular, is a complex network of both sympathetic and parasympathetic nerves, leading to unpredictable outcomes following peripheral nerve injuries in this region. The examination of these patients begins with a careful history of preprocedural urinary symptoms to differentiate between new and old symptoms. Symptom questionnaires are useful in obtaining a clear picture of current symptoms but are also a reliable way to measure changes in patient symptoms over time. Postoperatively, patients may present with clear urinary retention.
Neurosurgery: Minimally invasive neurosurgery
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
Charu Mahajan, Indu Kapoor, Hemanshu Prabhakar
Lumbar spine stabilization is often required in geriatric patients having trauma, degenerative changes, infection, or malignancy. Minimally invasive techniques for spinal fusion are anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion, transforaminal lumbar interbody fusion, intertransverse fusion, and pedicle screw/rod placement. Decreased muscle and soft tissue injury, decreased operative time, less blood loss, less pain, earlier mobilization, and faster return to work are important advantages of minimally invasive surgery. ALIF can be done through either the laparoscopic transperitoneal or retroperitoneal route. The transperitoneal route provides the best access to the L5−S1 level, as the bifurcation of great vessels lies above this level. However, injury to the bowel, superior hypogastric plexus, and blood vessels are potential concerns. Retroperitoneal lumbar fusion is performed either in the supine or lateral decubitus position using carbon dioxide (CO2) insufflation, balloon insufflation, or a combination of both to create and maintain the retroperitoneal working cavity. The related concerns of laparoscopic surgery such as trendelenburg position hypercapnia, right bronchus intubation, and CO2 embolism should be kept in mind. Transforaminal, posterolateral procedures and percutaneous spinal fixation are performed in the prone position.
Topography of the pelvic autonomic nerves – an anatomical study to facilitate nerve-preserving total mesorectal excision
Published in Acta Chirurgica Belgica, 2022
Jan Gaessler, Friedrich Anderhuber, Sabine Kuchling, Ulrike Pilsl
After separation of the rectum from the sigmoid colon, the parietal peritoneum covering the lumbosacral junction was longitudinally incised via a midsagittal section. Following the detection of the hypogastric nerves arising from the superior hypogastric plexus (SHP), development of the posterior plane was pursued. This was achieved through careful separation of the presacral fascia and the posterior aspect of the MRF by use of sharp dissection. Tracking the hypogastric nerves downwards, the inferior hypogastric plexus (IHP) was reached and subsequently exposed through mobilisation of the lateral aspects of the rectum. Hereafter, the anterior aspect of the MRF was exposed via sharp dissection behind the RGS. Finally, the ureters were exposed with particular focus on their course in relation to the plane of dissection in TME.
Surgical Approach for Enlarged Uteri: Further Tailoring of vNOTES Hysterectomy
Published in Journal of Investigative Surgery, 2022
Giovanni Buzzaccarini, Guglielmo Stabile, Péter Török, Stamatios Petousis, Mislav Mikuš, Luigi Della Corte, Fabio Barra, Antonio Simone Laganà
In this scenario, vaginally Assisted Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is one of the most innovative surgical techniques which is currently under the spotlight. Apart from gynecological conditions, vNOTES was also used in a hybrid manner in other medical specialties, such as in case of nephrectomy [2]. As far as gynecological surgery is concerned, vNOTES hysterectomy is gaining continuous popularity. This technique provides the peculiar feature of combining the advantages of both vaginal hysterectomy (VH) and laparoscopic hysterectomy (LH). One of the most important benefits is the lack of visible scars, which results in an optimal cosmetic outcome. Moreover, vNOTES hysterectomy provides a shorter duration of surgery, as well as reduction of post-operative pain, due to the vaginal access route. Moreover, the use of endoscopic visualization helps to increase the safety of the procedure compared to “classic” VH, allowing the easy identification of uterine vessels and ligaments. However, this technique should be performed only after adequate training, since the transvaginal access could lead to specific complications. In particular, the pelvic cavity can be not accessed if the incision is too close to the uterus; in addition, the bowel and rectum could be injured; finally, the hypogastric plexus could be damaged during of transection of the uterosacral ligaments [3].
Superior hypogastric plexus block as an effective treatment method for endometriosis-related chronic pelvic pain: an open-label pilot clinical trial
Published in Journal of Obstetrics and Gynaecology, 2021
Sepideh Khodaverdi, Mahmoud Reza Alebouyeh, Kambiz Sadegi, Abolfazl Mehdizadehkashi, Mania Kaveh, Saeid Reza Entezari, Hossein Mirzaei, Mojdeh Khaledi, Maryam Khodaverdi
The superior hypogastric plexus (SHP), as a retroperitoneal structure, is located bilaterally between the fifth lumbar and the first sacral vertebra in a sacral promontory. This network innervates the pelvic floor and genitalia through the nerves of hypogastric plexus that is the main cause of pelvic pain (Jones and Rock 2015). Safety and efficacy of SHP block have been reported in the treatment of CPP, especially in patients with pelvic cancers and secondary dysmenorrhoea (Plancarte et al. 1997; Yang et al. 2018). However, the efficacy of SHP block in pain management in patients with refractory endometriosis has not been investigated in earlier investigations. In this study, we aimed to evaluate the effect of SHP block on pain and quality of life of patients with refractory endometriosis who were irresponsive to medication therapy.