Anatomical and surgical insights for hypogastric nerves preservation during pelvic retroperitoneal dissection

Manuela Mastronardi, Anna Maria Billi, Giulia Adalgisa Mariani, Sara Mongiorgi, Desiree Martini, Mohamed Mabrouk, Renato Seracchioli, Lucia Manzoli
In: Italian Journal of Anatomy and Embryology · 2018 · pp. 142 · doi:10.13128/ijae-11453 · W7143853609
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⚙ AI-generated summary by claude@2026-06, 2026-06-13 ⓘ

This study dissected female pelves to identify hypogastric nerve anatomical relationships and found significant right-left differences, suggesting an interfascial approach for nerve preservation during pelvic surgery.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-13 · read from full text ⓘ

The paper studied the anatomical relationship between hypogastric nerves and pelvic anatomical landmarks, and assessed right–left differences, using detailed pelvic retroperitoneal dissections. In 5 nulliparous embalmed cadavers and 10 nulliparous women undergoing in vivo laparoscopic surgery for rectosigmoid endometriosis (without parametrial infiltration or radical hysterectomy), the closest distances between the hypogastric nerves and ureters, as well as distances relative to midline planes and uterosacral ligaments, were documented on both hemipelvis. Hypogastric nerves were identified bilaterally in all specimens, but substantial anatomical variability was observed; notably, the right hypogastric nerve was farther from the ureter relationship-wise and closer to the midsagittal plane than the left, with additional side-specific differences relative to mid-cervical plane and uterosacral ligaments. The authors emphasize that variability limits generalization and argue that an interfascial approach could support nerve-sparing surgery, while this remains grounded in specific surgical contexts. This paper is centrally about endometriosis — it reports in vivo laparoscopic dissections in women undergoing surgery for rectosigmoid endometriosis and frames the nerve-sparing pelvic retroperitoneal anatomy in that operative setting.

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Abstract

During several gynecological retroperitoneal pelvic surgeries, portions of the pelvic auto- nomic nervous system can be accidentally damaged, in particular hypogastric nerves, leading to significant visceral dysfunctions, dramatically affecting woman’s quality of life. The aims of this study were to clarify the relationship of hypogastric nerve with definite anatomical land- marks and to assess any anatomical differences between the two sides of the pelvis. Detailed pelvic retroperitoneal dissection was performed in 5 nulliparous embalmed female cadavers and in 10 nulliparous women during in vivo laparoscopic surgery for rectosig- moid endometriosis without parametrial infiltration or radical hysterectomy (B1 according to Querleu-Morrow) for cervical cancer. On both hemipelvis, the closest distance between HNs and ureters, midsagittal plane, midcervical plane or uterosacral ligaments were documented. Comparison of anatomical data of the two hemipelvis were conducted. On cadavers and in vivo dissection, a right and left hypogastric nerves, covered by pre- hypogastric fascia, were identified in all specimens. Irrespective of the side, a wide anatomical variability was reported. Regarding differences between the two hemipelvis, we found that the right hypogastric nerve was further to the ureter and closer to the midsagittal plane than the left one. Mid-cervical plane was found 2.7 mm to the left of the midsagittal one. Right hypogas- tric nerve was found closer to mid-cervical plane and utero-sacral ligament than the left one. An accurate knowledge of the pelvic retroperitoneal anatomy and differences between the two sides of the pelvis are essential to preserve hypogastric nerve during surgical dissection. Because of the wide anatomical variability, the use of an interfascial approach between fascia propria recti and pre-hypogastric fascia could help to perform an efficient nerve-sparing sur- gery.
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Anatomical and surgical insights for hypogastric nerves preservation during pelvic retroperitoneal dissection Published 2018-12-30 How to Cite Abstract During several gynecological retroperitoneal pelvic surgeries, portions of the pelvic auto- nomic nervous system can be accidentally damaged, in particular hypogastric nerves, leading to significant visceral dysfunctions, dramatically affecting woman’s quality of life. The aims of this study were to clarify the relationship of hypogastric nerve with definite anatomical land- marks and to assess any anatomical differences between the two sides of the pelvis. Detailed pelvic retroperitoneal dissection was performed in 5 nulliparous embalmed female cadavers and in 10 nulliparous women during in vivo laparoscopic surgery for rectosig- moid endometriosis without parametrial infiltration or radical hysterectomy (B1 according to Querleu-Morrow) for cervical cancer. On both hemipelvis, the closest distance between HNs and ureters, midsagittal plane, midcervical plane or uterosacral ligaments were documented. Comparison of anatomical data of the two hemipelvis were conducted. On cadavers and in vivo dissection, a right and left hypogastric nerves, covered by pre- hypogastric fascia, were identified in all specimens. Irrespective of the side, a wide anatomical variability was reported. Regarding differences between the two hemipelvis, we found that the right hypogastric nerve was further to the ureter and closer to the midsagittal plane than the left one. Mid-cervical plane was found 2.7 mm to the left of the midsagittal one. Right hypogas- tric nerve was found closer to mid-cervical plane and utero-sacral ligament than the left one. An accurate knowledge of the pelvic retroperitoneal anatomy and differences between the two sides of the pelvis are essential to preserve hypogastric nerve during surgical dissection. Because of the wide anatomical variability, the use of an interfascial approach between fascia propria recti and pre-hypogastric fascia could help to perform an efficient nerve-sparing sur- gery.

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