video 1left paraaortic , inframesenteric lymphadenectomy supported by icg labelling in cervical cancer.video 1 left paraaortic , inframesenteric lymphadenectomy supported by icg labelling in cervical cancer .
 superior hypogastric plexus ( shg ) contains mainly sympathetic and most probably also postganglionic parasympathetic fibers . 
 thus , surgical damage of shg may cause autonomic pelvic organ dysfunction ( kraima et al . , 2015 ) . 
 as already shown for rectal cancer , preservation of the autonomic nerves is facilitated by robotic surgery and may avoid sexual dysfunctions and voiding disorders ( kim et al . , 2015 ) . 
 in this educational video , we demonstrate left lower paraaortic lymph node dissection preserving the shg using icg fluorescence to label the lymphatic compartment.prior to total mesometrial resection ( tmmr ) with therapeutic lymphadenectomy for cervical cancer ( hckel et al . , 2009 , kimmig et al . , 2013 ) 4    0.5  ml of a 1.66  mg / ml indocyanine green solution ( icg pulsion , pms se , feldkirchen , germany ) was injected into the uterine cervix at all four quadrants , 0.5  cm in depth ( kimmig et al . 
 , 2016).the lymphatic network of the downstream common iliac and inferior paraaortic lymph compartments of the uterine cervix is visualized ( icg fluorescence ) including the individual connecting vessels between the different compartments . 
 as can be demonstrated , the medial upper common iliac ( subaortic ) compartment drains preferentially into the anterior ( mesenteric ) compartment , whereas lateral common iliac lymphatic vessels mainly drain to the posterior ( lumbar ) paraaortic compartment . 
 the autonomic nerve fibers of the shp may easily be identified and preserved due to the excellent image resolution and the discrimination from fluorescent lymphatic structures . 
 the video shows the preparation of left lower paraaortic nodes in cervical cancer following icg labeling using a da vinci xi system. this technique seems not only advantageous for preserving shp , but even more highly educational to learn surgical anatomy for trainees . 
Supplementary data