腹腔镜神经保护根治性子宫切除术3型（C1）与环状PLND

                               
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Background
To avoid bowel, bladder, and sexual dysfunction, a nerve-sparing radical hysterectomy has been developed. The operation seems to be associated with prompt recovery of bladder function, minimal need for self-catheterization, and less bowel dysfunction.

Introduction: From the superior hypogastric plexus located over the sacral promontory, two hypogastric nerves containing sympathetic fibers run into the small pelvis beneath the ureter and are responsible for such functions as bladder compliance, urinary continence, and small muscle contractions at orgasm. The hypogastric nerves fuse with parasympathetic fibers of the pelvic splanchnic nerves, coming from sacral roots 2, 3, and 4, to form the inferior hypogastric plexus, which is situated in the dorsal part of the parametrium and the dorsal vesicouterine ligament. The parasympathetic fibers are responsible for vaginal lubrication and genital swelling during sexual arousal, detrusor contractility, and various rectal functions.

Method: This Laparoscopic surgery video demonstrates the identification of the hypogastric nerves fuse with parasympathetic fibers of the pelvic splanchnic nerves, coming from sacral roots 2, 3, and 4, to form the inferior hypogastric plexus (IHP), and sparing the nerve plexuses by dissection of the uterosacral ligament to lateralise the hypogastric nerves and sparing the inferior hypogastric plexus by dissection parametrium at the level of deep uterine vein.

Conclusion: The inbuilt natural endoscopic magnification facilitates the better visualization of pelvic nerves and guides in fine dissection of hypogastric, splanchnic, and IHP at the level of uterosacral ligament and deep uterine vein. The preservation of nerves is important to prevent post-operative bowel, bladder and sexual dysfunctions in patients with early stage cervical cancers.