{"paper_id":"32e157ba-13c4-458c-a198-7ab385b6f48b","body_text":"Abstract\nBackground\nEfforts to improve approaches to the so called “parametrium” with minimally invasive and less dangerous techniques have led to a better study of the anatomic location and composition of that region. Nevertheless, many misconceptions and confusions about the anatomy of the posterior parametrium and its structures still remain. This study aimed to review anatomic and surgical data and to identify several clear landmarks and surgical steps for a nerve-sparing approach to posterior parametrectomy in the course of radical pelvic surgery with or without rectal resection.\nMethods\nThe literature and anatomic dissections of fresh, embalmed, and formalin-fixed female pelvis cadavers were reviewed. The authors’ laparotomic and laparoscopic case series also was reviewed for deep-infiltrating endometriosis as well as uterine, ovarian, and rectal cancer.\nResults\nThe anatomic entity commonly termed the “posterior parametrium” can be identified as the conjunction of three important anatomic structures (ligaments): the cranial structure (uterosacral ligaments), the caudad structure (rectovaginal ligaments), and the laterocaudad structure (lateral rectal ligaments). Identification of these structures (containing autonomic innervations for pelvic viscera) may allow an accurate nerve-sparing surgical approach in many radical pelvic operations.\nConclusions\nThe incidences of urinary, rectal, and sexual morbidity after radical pelvic surgical procedures for oncologic diseases (rectal/ovarian cancer, advanced endometrial/cervical cancer, posterior pelvic recurrences) and deep severe endometriosis can be reduced by better knowing and dissecting the right embryo-anatomic planes of the so-called “posterior parametrium.”\nSimilar content being viewed by others\nReferences\nAllen DR, Heald RJ (1983) Rectocolectomy with anal conservation in inflammatory colitis. Ann R Coll Surg Engl 65:347\nErcoli A, Delmas V, Gadonneix P, Fanfani F, Villet R, Paparella P, Mancuso S, Scambia G (2003) Classical and nerve-sparing radical hysterectomy: an evaluation of the risk of injury to the autonomous pelvic nerves. 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We gratefully acknowledge Mr. Adolfo Bigioni for his accomplished anatomic illustrations.\nDisclosures\nMarcello Ceccaroni, Roberto Clarizia, Giovanni Roviglione, and Giacomo Ruffo have no conflicts of interests or financial ties to disclose.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nRights and permissions\nAbout this article\nCite this article\nCeccaroni, M., Clarizia, R., Roviglione, G. et al. Neuro-anatomy of the posterior parametrium and surgical considerations for a nerve-sparing approach in radical pelvic surgery. Surg Endosc 27, 4386–4394 (2013). https://doi.org/10.1007/s00464-013-3043-z\nReceived:\nAccepted:\nPublished:\nIssue date:\nDOI: https://doi.org/10.1007/s00464-013-3043-z","source_license":"CC0","license_restricted":false}