Applied surgical anatomical approach to pudendal nerve: Step-by-step key neurovascular structures for pelvic nerve surgery.

Abstract

Objective: To define and demonstrate a step-by-step surgical anatomical approach to pudendal nerve dissection using female cadavers, focusing on the identification of safe roadmap and key neurovascular structures to optimize pelvic nerve surgery.

Methods: A descriptive anatomical study was conducted on 60 hemipelvises from 30 female cadavers. Dissections were performed in three stages comprising nine procedural steps to expose the pudendal nerve and related pelvic nerves. Key neurovascular landmarks were documented using video recordings.

Results: The dissection was organized into three stages: (1) exposure of the genitofemoral nerve and obturator fossa and its contents, (2) identification of the lumbosacral trunk and sciatic nerve, and greater sciatic notch (3) visualization of the pudendal nerve beneath the sacrospinous ligament. Variations in pudendal nerve branching and anatomical relationships with adjacent structures, including the sacrospinous ligament and ischial spine, were documented. This stepwise approach provided clear surgical landmarks to minimize the risk of nerve injury during pelvic surgery.

Conclusion: This cadaveric study provides a detailed, practical roadmap for pudendal nerve dissection, enhancing anatomical understanding of pelvic neurovascular structures. The defined surgical approach in three stages, nine steps, and this comprehensive anatomical understanding can improve surgical precision and supports safer nerve-sparing techniques in complex pelvic surgery including gynecologic pelvic surgical procedures, surgeries for pudendal neuralgia, and deep infiltrating endometriosis.