Below the Aortic Bifurcation

Visceral nerves often travel along big vessels. The superior hypogastric plexus in front of the aorta ends when this vessel forms the right and left iliac arteries. The outflow of the superior hypogastric plexus is the right and left hypogastric nerves. It should be mentioned that difficulties in avoiding damage to these structures may occur due to the large variability of these nerves. Careful dissection under the aortic bifurcation in the midline towards the pelvic rim will avoid damage. By proceeding laterally these important nerve structurs can be easily identified.

We always identify the left ureter at the iliac crest, which runs medial from the gonadal vein (squeezing). The fascial structures must be obeyed. From the embryological point of view the visceral and somatic "body" merge in the small pelvis and must be identified to do the dissection in the bloodless and oncological correct plane. Stelzner called the visceral body envelopping fascia "Grenzlamelle" [17]. Clinically surgery must be done between the "Grenzlamelle" and the fascia pelvis parietalis interna, which covers the muscles of the small pelvis. Inside the small pelvis the visceral nerves (sympathetic Plexus hypogastri-cus, parasympathetic Plexus pelvicus) are situated, the somatic structures Plexus pudendalis - pudendal nerve lies under the fascia pelvis parietalis interna travelling to the muscles of the pelvic floor using Alcock's canal to reach the external anal sphincter complex.

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