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Nerve-Sparing Routes in Radical Pelvic Surgery

  • Nucelio L. B. M. Lemos
  • Reitan Ribeiro
  • Gustavo Leme Fernandes
  • Mauricio S. Abrão
  • Renato Moretti-Marques
Chapter

Abstract

Wertheim’s, Okabayashi’s, and Meig’s work, already in the early 1900s, progressively increased the radicality of hysterectomy for early-stage cervical cancer, mainly by increasing the extent of parametrial excision, correspondingly increasing survival rates [1]. Increased survival, however, charged its price by adding functional morbidity to cancer survivors—prevalence of urinary retention, constipation, and sexual dysfunction rose almost proportionally to survival rates [2, 3]. Those dysfunctions derive from the damage inflicted to the pelvic sympathetic and parasympathetic neural pathways—superior hypogastric plexus, hypogastric nerves, pelvic splanchnic nerves, and the inferior hypogastric (pelvic) plexus. Therefore, the objective of this chapter is to review the anatomy of the autonomic nerves of the pelvis and describe the steps of the LANN technique to expose and preserve the autonomic nerves, as well as the anatomical landmarks to preserve those nerves without the need of previously exposing them.

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Nucelio L. B. M. Lemos
    • 1
  • Reitan Ribeiro
    • 2
  • Gustavo Leme Fernandes
    • 3
  • Mauricio S. Abrão
    • 4
  • Renato Moretti-Marques
    • 5
  1. 1.Department of Obstetrics and GynecologyUniversity of Toronto, Women’s College HospitalTorontoCanada
  2. 2.Gynecologic Oncology DepartmentErasto Gaertner, Instituto de Oncologia do Paraná, and Hospital Marcelino ChampagnatCuritibaBrazil
  3. 3.Gynecology Oncology Division, Department of Obstetrics and GynecologyCentral Hospital of Irmandade da Santa Casa de Misericórdia de São PauloSão PauloBrazil
  4. 4.Ob/Gyn DepartmentSao Paulo UniversitySao PauloBrazil
  5. 5.Oncology DepartmentHospital Israelita Albert EinsteinSão PauloBrazil

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