702-ANAT
Pelvic Anatomy Related to Nerve-Sparing Gynecologic Surgery: A Consensus on Terminology

Chairs: Nucelio Lemos, Jason A. Abbott
Faculty: Anna Kobylianskii, Peter Thiel, Meghan McGrattan,

Description: Nerve-sparing gynecologic surgery was initially developed to mitigate the effects of radical hysterectomy for malignancy on urinary, defecatory, and sexual functions [1]. Nerve-sparing techniques have also been adapted to benign gynecologic surgery, allowing for complete excision of deeply infiltrating endometriosis (DIE) while preserving autonomic pelvic function [2]. Despite improved nerve fiber visualization through laparoscopy, implementation of nerve-sparing techniques has been limited [3]. One barrier to the widespread implementation of nerve-sparing surgery is the inconsistency in terminology, which includes the use of several different terms for the same anatomical structure within the same article [4]. To undertake precision surgery that can be taught and compared in research, it imperative that terminology be consistent, exact and transferable. Such an approach will provide a sound basis for surgical studies in this evolving area to be meaningful and have impact on women's health and surgery. Inconsistent anatomical terminology is not unique to gynecology, with X and Y. Such inconsistency makes studying, understanding, and learning nerve-sparing approaches more challenging. To standardize anatomical terminology, the International Federation of Associations of Anatomists published Nomina Anatomica, followed by Terminologia Anatomica (TA), the second edition published in 2019 [5,6]. This work has become the international reference for anatomical terms and is the result of monumental efforts by the anatomist community. Nevertheless, clinicians and researchers continue using differing terms for pelvic structures, suggesting a disconnect between anatomists' and surgeons' perspectives. A structured literature review of the variations in pelvic anatomical nomenclature was undertaken and reviewed by members of this group and published in the JMIG [7]. This initial work identified different terms used in scientific publications for pelvic autonomic nerve bundles, fasciae and spaces. Considerable improvements in the manuscript were made following deep and respectful academic discussion regarding specific anatomy, consistency of terminology and recognition of areas of ongoing concern. The senior author of the paper (NL) consulted with the Co Editors-in-Chief of the JMIG, requested a break in the anonymity of reviewers, with a blinded, informed consent process undertaken with each reviewer so that further collaboration could be achieved for a consensus process in this field.

Learning Objectives: At the end of this course, the participant will be able to:
Establish consensus on terminology for pelvic anatomy critical to nerve-sparing surgery,
Promote international collaboration to advance standardization in gynecologic surgery;
Create a foundation for future education, research, and dissemination of nerve-sparing techniques.

Course Outline
9:15 AM Welcome, Introduction and Course Overview
N. Lemos
9:20 AM Anatomical Overview, Terminological Inconsistencies, and Implications for Nerve-Sparing Surgery
A. Kobylianskii
9:40 AM Defining and Standardizing Terms for Fasciae and Ligaments Critical for Nerve-Sparing Procedures
P. Thiel
10:00 AM Clarifying Terminology for Retroperitoneal Spaces to Guide Surgical Dissection and Improve Outcomes
M. McGrattan
10:20 AM Expert Panel Discussion and Vote
M. Barbe, M. Siedhoff, S. Choi, M. Mabrouk, D. Raimondo, B. Rabischong
11:15 AM Adjourn