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

Conclusion Il existe six sites anatomiques décisifs à connaître pour limiter les séquelles fonctionnelles nerveuses de cette chirurgie. La mise en application des principes de la préservation nerveuse au cours de la chirurgie pour endométriose serait associée à une meilleure satisfaction postopératoire à court terme et à une diminution des troubles fonctionnels urinaires. Objectives Deep 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. Methods The 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. Results Six 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 ...
Source: Gynecologie Obstetrique and Fertilite - Category: OBGYN Source Type: research