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Introduction: The porta hepatis is bounded anteriorly by the quadrate lobe and posterosuperiorly by the caudate lobe. The hepatic artery with the autonomic plexus around it and the portal vein enter the liver through the porta hepatis, while the two hepatic ducts and some lymphatics emerge out from the liver through it. The porta hepatis of the liver is a very important area surgically. The knowledge of the variations in the structures passing through the porta hepatis might be of great help in reducing the risks of surgery in this area. Materials and Methods: The study was conducted in the Department of Anatomy of our institution after obtaining the ethical clearance.87 liver specimens in the Department were used for the study. The liver specimens will be removed during routine dissection for medical undergraduate teaching and would be preserved in 10% formalin. Conclusion: The incidence of variations in the portal venous system can be of prime surgical and radiological importance for portocaval anastomosis and to study hemodynamic flow radiologically. This study highlights the various possible combinations of the structures at the porta hepatis and is thereby useful for the radiologists and surgeons dealing with this region.

Surgery remains the cornerstone of a multimodality approach aimed at cure in pancreatic cancer (PC). To improve outcomes in PC and widen the indications for surgical resection, surgeons have targeted borderline-resectable (BR) and locally advanced (LA) tumours having demonstrated the feasibility of synchronous arterial (SAR) and venous resections (SVR). However, the true benefit of SARs in PC in terms of improving overall survival has not been fully realised. One of the reasons for this lies in the fact that once the tumour involves the artery, it has already spread along the perineural autonomic plexus that surround it, resulting in early extended local and distant cancer dissemination. Thus, before advocating for the performance of routine SARs in PC, it is important to critically analyse the evidence and develop a structured framework to test if these operations truly hold a beacon of hope for patients with LAPC.

The nerves located in the deepest areas can be exposed and dissected via laparoscopic magnification. This technological innovation does not only help us to avoid surgery-related complications but also allows us to diagnose the vascular entrapment syndromes. The aim of this article is to demonstrate female neuroanatomy and autonomic plexus via enriched photos and videos to reveal the relationship of the pelvic nervous system with gynecological operations.

The superior hypogastric plexus (SHP) is the part of the autonomic nervous system, which is responsible for the sympathetic innervation of pelvic organs and extrapelvic genitals in humans of both sexes. The SHP also functions as the anatomic pathway for the major part of visceral sensitive fibers originating from pelvic viscera. In this study, the morphology of the SHP was analyzed through anatomical dissections performed both in human adult and fetal cadavers. A computerized morphometrical investigation of the SHP was also performed and the resulting quantitative data statistically assessed. The comparison between fetal and adult SHP revealed that in the male group there was a developmental increase of six times (in height) and of about five times (in width); while in the female group, there was a developmental increase of 3.5 times both in height and width values. In addition, the distance from the superior border of the SHP to the bifurcation of the common iliac arteries presented a developmental increase of about six times in the male group, and about four times in the female group. We propose an original morphological classification with six types, based upon the anatomical arrangement of the nervous fibers in this autonomic plexus. Clin. Anat. 23:962–970, 2010. © 2010 Wiley-Liss, Inc.

Bladder dysfunction following colorectal surgery may be related to extirpative procedures in the region of the pelvic autonomic plexus. The most common etiology is from autonomic disruption during abdominoperineal or low anterior resections. Contemporary technical modifications have allowed surgeons to achieve oncologic control while preserving the autonomic nerves that innervate the bladder and sexual organs. Although these modifications have resulted in a significant decrease in the incidence of postoperative bladder dysfunction, bladder dysfunction continues to be a source of significant morbidity after surgery. In this patient population, symptoms are not reliable for accurate diagnosis. The use of urodynamics provides objective measurements of bladder and outlet function and are paramount in providing an accurate diagnosis and in recommending treatments. Follow-up and treatment are highly individualized based on urodynamic findings, patient expectations, patient abilities, and family support. This article provides an overview of pertinent neuroanatomy, diagnosis, urodynamic interpretation, and treatment related to bladder dysfunction following pelvic colorectal surgery.

Radical cystectomy is the definitive surgical treatment for a high-risk and invasive bladder and is governed by the general principles of aggressive extirpation. In the modern era, understanding the functional anatomy of the pelvic autonomic plexus and cavernosal nerves has facilitated the development of techniques of radical cystectomy which spare sexual function without compromising on the primary goal of oncological control. This chapter describes the surgical anatomy and approaches and outcomes relevant to the nerve sparing radical cystectomy.

This investigation was an anatomical study to determine whether branches of the pre-sacral autonomic plexus cross the posterior plane of surgical dissection to supply the rectum. Initially four cadaver hemi-pelves were dissected. Twelve patients undergoing full rectal mobilization were then studied at operation. In all subjects the pre-sacral nerves were arranged as a plexus below the sacral promontory, rather than as individual left and right nerve trunks. Structures thought to be nerves were identified crossing the plane of posterior mobilization of the rectum. They were traced towards their origin and destination, photographed and representative fibres biopsied. A total of 42 such structures were biopsied (16 in cadavers, 26 in operative cases) and 40 were confirmed to be nerves. These nerves connect the pre-sacral autonomic plexus with the posterior aspect of the rectum and were found at all sacral levels. In the operative cases the level of the positive biopsies were S1-six, S2-six, S3-five, S4-four, S5-three. The posterior plane of rectal dissection is therefore crossed by autonomic nerves that innervate the rectum. The pre-sacral nerves have been found to form a plexus in all subjects.