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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].
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.
Abdomino-Perineal Excision for Rectal Cancer
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
The pelvic dissection during the inter-sphincteric APE is identical to that performed for AR, described previously. In summary, the loose connective tissue plane (‘the holy plane’) separating the mesorectal fascia from the parietal pelvic structures is identified and followed first posteriorly, then to the left and right and finally anteriorly whilst the peritoneum is gradually divided. A gentle traction on the specimen and counter-traction with appropriate retractors is crucial to achieve a good view of this plane. The superior hypogastric plexus is identified at the sacral promontory and the hypogastric nerves should be identified, protected and preserved whilst the dissection gradually proceeds downwards in the pelvic cavity. Anteriorly the dissection is conducted just posterior to the seminal vesicles and prostate in the male and the vagina in the female. The lower anterior-lateral dissection is the most difficult part of the abdominal phase of the operation because the correct plane is often difficult to find here and the inferior hypogastric plexus must be carefully preserved to maintain post-operative sexual and urinary function. Reducing the angle of the Trendelenburg position or even shifting the patient to a reverse Trendelenburg position may facilitate the exposure for the anterior dissection.
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.
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.
Role of interventional pain management in patients with chronic pelvic pain
Published in Baylor University Medical Center Proceedings, 2020
Jamal Hasoon, Ivan Urits, Vwaire Orhurhu, Omar Viswanath, Musa Aner
A diagnostic and therapeutic bilateral superior hypogastric plexus block was performed under image guidance with the use of 8 mg of dexamethasone and 18 mL of 0.25% bupivacaine, divided equally for each side (Figure 1). The patient reported significant improvement shortly after the procedure was performed that lasted 4 months. She continues to receive repeat injections, with each injection providing 70% to 80% pain relief lasting approximately 4 months. She reported significant improvement in her pain scores and quality of life and was able to wean her opioid dose down to 15 morphine milligram equivalents with the addition of these pain procedures.