Journal of the European Society for Gynaecological Endoscopy


The anatomy of the pelvic plexus in female cadavers: implications for retroperitoneal nerve-sparing surgery

M. Mastronardi1, D. Raimondo2, M. Mabrouk3, A. Raffone2,4,5, M. Giorgi6, G. Centini6, E. Zupi6, R. Seracchioli2,4, M. Maletta2,4, S. Ratti7, W. M. O’guin8, l. Manzoli7, A. M. Billi7

1 General Surgery Unit, Cattinara University Hospital, 34128 Trieste, Italy
2 Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
3 Department of Obstetrics and Gynecology, Faculty of Medicine, University of Cambridge, CB2 1TN Cambridge, United Kingdom
4 Department of Medical and Surgical Sciences, DIMEC, University of Bologna, 40138 Bologna, Italy
5 Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80138 Naples, Italy
6 Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy
7 Biomedical and Neuromotor Sciences, Dipartimento di Scienze Biomediche e NeuroMotorie (DIBINEM), University of Bologna, 40138 Bologna, Italy
8 Department of Cell Biology, New York University School of Medicine, 10016 NY, USA


Cadavers, pelvic plexus, gynaecologic surgery, nerve-sparing surgery, anatomical landmarks

Published online: Jun 28 2024


Background: The inferior hypogastric plexus (IHP) is a crucial structure for female continence and sexual function. A nerve-sparing approach should be pursued to reduce the risk of pelvic plexus damage during retroperitoneal pelvic surgery.

Objectives: To analyse the relationship between the female IHP and several pelvic anatomical landmarks.

Materials and Methods: Standardised cadaveric dissection was performed on 5 nulliparous female cadavers. The relationships of the IHP and the mid-cervical plane (MCP), the mid-sagittal plane (MSP), and the uterosacral ligament (USL) were investigated.

Main outcome measures: Distance between IHP and MCP, MSP, and USL.

Results: Distances between the right IHP and the right MSP (mean distance: 16.3 mm; range: 10.0-22.5 mm) and the right USL (mean distance: 4.8 mm; range: 0-15.0 mm) were shorter than those between the left IHP and ipsilateral landmarks (left MSP distance: 23.5 mm; range 18.0-30.0 mm; left USL distance: 5.0 mm; range: 0-20.0 mm). Although the MCP was 3.3 mm (range: 2.5-4.0 mm) left and lateral to the midsagittal line, the right IHP was closer to the MCP (mean distance: 19.6 mm; range: 13.0-25.0 mm) than the left one (mean distance: 20.2 mm; range: 15.0-26.0 mm).

Conclusions: Distances between the right IHP and the MSP, MCP, and ipsilateral USL, are shorter compared to these associated to the left IHP.

What is new? Right autonomic pelvic plexus is closer to the midline planes and the ipsilateral USL. These anatomical relationships may be greatly helpful for pelvic surgeon while facing retroperitoneal pelvic surgery and looking for a nerve-sparing approach.