Introduction/Background During radical pelvic surgeries fibers of the autonomic pelvic nervous network can be accidentally damaged leading to significant visceral sequalae, which dramatically affect women’s quality of life because of urinary, anorectal, and sexual postoperative dysfunctions. Direct visualization seems to be the only way to preserve hypogastric nerves(HNs), pelvic splanchnic nerves(PSNs), and the bladder branches from the inferior hypogastric plexus(IHP). However, the literature lacks critical photos and/or illustrations that are necessary to understand the precise anatomy needed to preserve the pelvic autonomic fibers. Here, we performed laparoscopic surgery, before LACC era, identifying key anatomic landmarks useful to highlight the path of the most commonly encountered autonomic pelvic nerves in gynecologic radical surgery: during the narration we describe and illustrate the procedure to identify all autonomic pelvic nerves, the sympathetic fibers, the PSNs, and the bladder branch emerging from the IHP in order to preserve their anatomic and functional integrity.

Methodology Narrated laparoscopic video footage for identifying, dissecting, and preserving the autonomic nerve bundles during pelvic surgery.

Results This technique is anatomically and surgically valid for adequate removal of the parametrial issues and vagina while preserving the total pelvic nervous system.

Conclusion Nerve-sparing¬ surgery reduces bowel-, bladder- and sexual­ dysfunction without decreasing surgical efficacy. The comprehension of the three-dimensional structure of the vascular and nerve anatomy in the pelvis is the right way to perform nerve sparing radical surgery effectively and safely. This video provides a great resource to educate surgeons, especially the youngest ones, about the retroperitoneal nervous networking: we identified the autonomic nerve pathway from adjacent tissues along the pathway consisting of cardinal, sacro-uterine, rectouterine/vaginal, and vesico-uterine ligaments.

Disclosures Nothing to disclose.