Deep infiltrating endometriosis with sacral plexus involvement: Improving knowledge through human cadaver dissection

Abstract

Introduction: The aim of this study was to assess a human cadaver model of sacral plexus dissection for learning about deep innervation in the female pelvis, and the latter's relationship with deep infiltrating endometriosis.

Methods: This was a prospective, observational study. Eight residents in obstetrics and gynecology were tested before and after a lecture on innervation of the female pelvis and a cadaver dissection class. Standardized cadaver dissection was used to identify the sacral nerve roots S2 to S4, superior and inferior hypogastric plexuses, hypogastric nerve, and splanchnic nerves.

Results: The residents' level of knowledge improved significantly after a one-hour lecture (p = 0.9.10^-5) and after a cadaver dissection class (p = 0.6.10^-6). The improvement was significantly greater for the dissection class (p = 0.0003). All the pelvic nerve structures were identified in all but one of the cadavers and had similar measurements. A vascular anatomical variant was observed in one case.

Conclusion: A human cadaver model is of value for learning about deep pelvic innervation and the latter's relationship with deep infiltrating endometriosis. The reproducibility and safety of cadaver dissection might improve surgical skills.

Keywords: Deep infiltrating endometriosis; Human cadaver dissection; Sacral roots; Sciatic nerve.