Nerve preserving vs standard laparoscopic sacropexy: Postoperative bowel function

Figure 1 Step 1: Opening the peritoneum. A: Schematic drawing of the “dissection triangle” on the right lumbosacral spine with the safe area (X) for opening the peritoneum; B: Laparoscopic view of the peritoneal opening point (X). rCIA: Right common iliac artery; SP: Sacral promontory; AB: Aortic bifurcation; SHP: Superior hypogastric plexus; rHN: Right hypogastric nerve; lHN: Left hypogastric nerve; InfVC: Inferior vena cava; lCIV: Left common iliac vein.

Figure 2 Step 1: Presacral fascia displacement, prevertebral fascia opening. A: The imaginary outline of the “dissection triangle” on the right lumbosacral spine between the four anatomical landmarks; B: Presacral fascia displacement not beyond the middle sacral vein (msv); C: Presacral fascia and prevertebral fascia; D: Denuded periosteum after prevertebral fascia opening. rCIA: Right common iliac artery; SP: Sacral promontory; AB: Aortic bifurcation.

Figure 3 Step 2: Opening of the peritoneum on the right pelvic sidewall. A: Schematic drawing of the dissection line (green arrow) and the autonomic pelvic nerves; B: Dissection line (dotted green line) at the cross of the caudal proximal third of the uterosacral ligament. Modified from Ceccaroni M, Fanfani F, Ercoli A, Scambia G (2006). Innervazione viscerale e somatica della pelvi femminile. CIC Edizioni Internazionali, Roma. rHN: Right hypogastric nerve.