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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].
Transanal Total Mesorectal Excision in Rectal Cancer (TaTME)
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Roel Hompes, Marta Penna, Joep Knol
The available evidence on quality of life and functional outcomes after TaTME are scarce. Theoretically TaTME should facilitate a meticulous dissection in the correct embryological plane avoiding injury to the pelvic hypogastric or sacral splanchnic nerves. Injury to these nerves can lead to urinary and sexual dysfunction,27,28 with reported incidences of 0%–26% and 11%–38% respectively after laparoscopic or open TME.29–31 Furthermore, up to 80% of patients after a restorative low anterior will suffer post-operatively from disordered bowel function.32
MRI evaluation of endopelvic fascial swelling and analysis of influencing factors in patients with uterine fibroids after high-intensity focused ultrasound ablation
Published in International Journal of Hyperthermia, 2020
Ya-Jiao Zhang, Zhi-Bo Xiao, Fu-Rong Lv, Bo Sheng, Jia Li, Yi-Neng Zheng, Fa-jin Lv, Jin-Yun Chen
The principle of HIFU is to bring a high-intensity ultrasound beam to a tight focus deep within the tissue, which raises the temperature of the target area rapidly to between 60 °C and 100 °C within 0.5–1.0 s, causing coagulative necrosis of the target [7]. However, adjacent thermal damage may occur during HIFU ablation and can include lower abdominal pain, sacrococcygeal pain and lower limb paresthesia. According to previous studies, signals changes were observed on T2-weighted imaging (T2WI) of the abdominal wall and sacrum on postoperative MRI [8,9]. In clinical practice, endopelvic fascial swelling has often been observed on postoperative MRI, in which a high-intensity signal is exhibited on T2WI. Under normal circumstances, the endopelvic fascia appears with a stripe-like low-intensity signal on T2WI, which is difficult to observe. The pelvic plexus, which is formed by the hypogastric nerve, pelvic splanchnic nerve and sacral splanchnic nerve, converges at the bottom of the rectum and is covered by the endopelvic fascia [10,11]. Nerve damage in patients with uterine fibroids after HIFU ablation may be correlated with endopelvic fascial swelling.