Identification des sites anatomiques à risque de lésion nerveuse lors de chirurgie pour endométriose pelvienne profonde

Fermaut M, Marion Fermaut, M Fermaut, Krystel Nyangoh Timoh, Nyangoh Timoh K, K Nyangoh Timoh, C. Lebâcle, C Lebacle, David Moszkowicz, D Moszkowicz, Benoit G, G Benoit, G Benoît, Bessede T, T Bessede, Thomas Bessède
Gynecologie, obstetrique & fertilite · 2016 · vol. 44(5) , pp. 302–308 · doi:10.1016/j.gyobfe.2016.03.007 · PMID:27118342 · W2336469167
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This study aimed to identify anatomical sites at risk of nerve injury during deep pelvic endometriosis surgery to improve surgical safety.

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Abstract

ObjectivesDeep pelvic endometriosis surgery may need substantial excisions, which in turn expose to risks of injury to the pelvic nerves. To limit functional complications, nerve-sparing surgical techniques have been developed but should be adapted to the specific multifocal character of endometriotic lesions. The objective was to identify the anatomical areas where the pelvic nerves are most at risk of injury during endometriotic excisions.MethodsThe Medline and Embase databases have been searched for available literature using the keywords "hypogastric nerve or hypogastric plexus [Mesh] or autonomic pathway [Mesh], anatomy, endometriosis, surgery [Mesh]". All relevant French and English publications, selected based on their available abstracts, have been reviewed. Five female adult fresh cadavers have been dissected to localize the key anatomical areas where the pelvic nerves are most at risk of injury.ResultsSix anatomical areas of high risk for pelvic nerves have been identified, analysed and described. Pelvic nerves can be damaged during the dissection of retrorectal space and the anterolateral rectal excision. Furthermore, before an uterosacral ligament excision, a parametrial excision, a colpectomy or a dissection of the vesico-uterine ligament, the hypogastric nerves, splanchnic nerves, inferior hypogastric plexus and its efferent pathways must be mapped out to avoid injury. The distance between the deep uterin vein and the pelvic splanchnic nerves were measured on four cadavers and varied from 2.5cm to 4cm.ConclusionSix key anatomical pitfalls must be known in order to limit the functional complications of the endometriotic surgical excision. Applying nerve-sparing surgical techniques for endometriosis would lead to less urinary functional complications and a better short-term postoperative satisfaction.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Gynecologic Surgical Procedures Hypogastric Plexus Pelvis Postoperative Complications Endometriosis Female Gynecologic Surgical Procedures Humans Hypogastric Plexus MEDLINE Pelvis Risk Factors

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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