Dissection of the Sympathetic Nerves Around the Mesorectum at the Abdominopelvic Border

Introduction Along the border between the abdominal cavity and pelvis are nervous structures that belong to the autonomous nervous system, which is delicate. These can be easily injured during regional surgical procedures such as the total mesorectal excision, where the preservation of the nervous structures should be one of the main objectives. In our study, we aimed to dissect all the sympathetic nerve formations listed at the abdominopelvic border and to present their formation, anatomical routes, and relations, as well as the surgical importance of their preservation. Method We performed anatomical dissections on eight 60- to 75-year-old cadavers (three male and five female) in the Dissection Laboratory of Carol Davila University of Medicine and Pharmacy, Bucharest, ROM. We sectioned each pelvis along the right pararectal line and exposed the hypogastric plexuses and their branches, following their pathways toward the pelvic viscera. Results We highlight the main nervous structures in the pelvis, namely the paravertebral sympathetic ganglion chain, which continues into the pelvis with the sacral ganglion chain, and the prevertebral component of the abdominal sympathetic system, represented by the superior hypogastric plexus and its continuation via the hypogastric nerves toward the inferior hypogastric plexuses. We followed the pathway of the superior hypogastric plexus from its origin down to its bifurcation into the two hypogastric nerves. We then followed the nerves into the pelvis and observed the formation of the inferior hypogastric plexuses, from which branches emerged toward the pelvic organs. Along the way, we point out anatomical landmarks that are crucial in an attempt to spare these nervous structures during regional surgical procedures. Conclusions While performing surgeries such as rectal resection with the excision of the mesorectum, radical hysterectomy, and radical prostatectomy, a thorough knowledge of the sympathetic nerve structures that pass from the abdominal cavity into the pelvis is required to spare pelvic innervation. In such a context, the dissection and anatomical assessment of regional sympathetic nerves can prove to be crucial in establishing operative protocols.