Anatomy & Nerve injuries w/ hysterectomy

Question 1

What can you do to avoid nerve injuries with a hysterectomy?

Answer 1

Lithotomy position. 2% risk of nerve injury following pelvic surgery. Increased risk injury for surgery <4 hours. If greater time, place pt in supine position for 30 min and then back to lithotomy.

Question 2

What is the saphenous nerve?

Answer 2

Saphenous nerve: branch of femoral nerve (supplies sensation to lower leg).
- pad MEDIAL ASPECT OF LOWER LEG to avoid injury.

Can be injured in abdominal and vaginal hysterectomy. Can affect ability to climb stairs.
PREVENT: pad medial aspect of lower leg

Question 3

What is the peroneal nerve?

Answer 3

(common fibular): originates from sciatic nerve. pads lateral lower leg. Presents as foot drop/difficulty dorsiflexing the foot.

Question 4

What is the sciatic nerve?

Answer 4

avoid compression of popliteal fossa
Position hips/knees in comfortable position. Supplies sensation to skin of the foot.

Question 5

What are the Ilioinguinal and genitofemoral nerves?

Answer 5

Originates from L1, L2.

injury causes parathesias of labial and upper thigh. sensory nerves that can be injured with incision. Can compress w/ lateral side wall retractors.

Question 6

What is the Lateral femoral cutaneous nerve?

Answer 6

Originates from L2/L3

Sensory innervation over the anterior thigh.

Question 7

What is the obturator nerve?

Answer 7

Originates from L2-4

sensory innervation of medial thigh and motor innervation of adductor muscles: hip flexion >90 degrees can cause injury. Obturator nerve can be injured during sling. Numbness of inner thigh, minor ambulatory probs

Question 8

What is the Pudendal nerve?

Answer 8

Originates from S2-4
can be injured during SS. No motor function. Sensation → vulvar pain.

Question 9

What are muscles of anterior abdominal wall?

Answer 9

3 flat muscles
- external oblique
- internal oblique
- transversus abdominis

1 strap muscle
- rectus abdominis

• inferior epigastric are located by elevating lateral edge of rectus muscle

Question 10

What is blood supply of ovary?

Answer 10

LEFT
- ovarian artery from branch of aorta
venous drainage into L renal vein

RIGHT
- ovarian artery from branch of aorta
- venous drainage into IVC.

Question 11

What is the hypogastric or internal iliac artery?

Answer 11

• primary artery supplying the pelvic viscera
• 3cm long, originates from common iliac at pelvic brim
• ANTERIOR DIVISION: supplies genitalia
• POSTERIOR DIVISION: avoid ligate to affect glut max
  – branches: I LOVE SEX (superior gluteal, iliolumbar, lateral sacral

Question 12

What are dermatomes?

Answer 12

Nipple : T4
Sternum T7
Umbilicus T10
Pubis L1-2

Question 13

What is pudendal nerve

Answer 13

roots S2-4
- innervates perineum

Question 14

What is nerve innervation of labor pain

Answer 14

1st stage of labor: T11-12
2nd stage of labor: S2-4 (pudendal nerve)

Question 15

What is iliohypogastric nerve?

Answer 15

T12-L1
- injure w/ suture entrapment w/ pfannensteil or direct cut
- sensory loss of skin over symphysis down to labia majora

Question 16

What is ilioinguinal nerve?

Answer 16

T12-L1 (same as iliohypogastric)
- injure w/ suture entrapment w/ pfannensteil or direct cut
- sensory loss of medial labia majora

Question 17

What is femoral nerve?

Answer 17

L2-L4
- cause: use of large self-retaining retractor or exaggerated hip flexion
- sensory loss of anterior/medial thigh
- inability to lieft knee

Question 18

What is lateral peroneal nerve?

Answer 18

L4-S2
- cause: lateral displacement of knee w/ insufficient knee support
- hyper-flexion of knee and hip
- causes foot drop

Question 19

What is sciatic nerve?

Answer 19

L4-S3
- cause: surgery in sacroiliac fossa (usually gyn onc),
- causes weak hamstrings and affects leg flexion

Question 20

What is Erb’s palsy?

Answer 20

C5-6
- waiter’s tip
- arm hangs at side, wrist flexed

Question 21

what is Klumpke’s palsy?

Answer 21

C8-T1
- problem for pianist
- hand and wrist paralysis. arm hangs flaccidly at side. LOSS OF GRASP REFLEX.

Question 22

What are common places of ureteral injury?

Answer 22

1. Lateral to cervix under cardinal ligament: damaged from ligating uterine.
2. Near uterosacral within broad: damaged from ligating uterosacral
3. Lateral pelvic side wall: damage from ligating infundibululopelvic (IP) ligaments.
4. Inserting into bladder wall: closing vaginal cuff.