Laparoscopic Neurolysis of the Sacral Plexus and the Sciatic Nerve for Extensive Endometriosis of the Pelvic Wall

Abstract

Background: The aim of this study is to report on the feasibility of laparoscopic neurolysis of the plexus sacralis and the sciatic nerve in deep endometriotic infiltration of the lateral pelvic wall.

Methods: A transperitoneal approach to the pelvic nerves combined with the LANN technique for intraoperative assessment of the function of the exposed nerves permit exposure and sparing of all somatic nerves during resection of the endometriotic lesion.

Results: We report on our short experience with 21 patients who underwent this technique for the treatment of endometriotic infiltration of the sacral plexus at different levels.

Conclusion: In young patients with chronic unilateral sciatica or unilateral pudendal neuralgia - Alcock's canal syndrome - where no neurological/orthopedic etiologies have been found, endometriotic infiltration of the lateral pelvic wall has to be implicated as a potential etiology and an indication for laparoscopy must be discussed. Laparoscopic neurolysis of the pelvic somatic nerves is a feasible procedure for trained laparoscopic surgeons who have a good knowledge of the retroperitoneal pelvic (neuro)anatomy.

Key words

Somatic pelvic nerve - laparoscopic neurolysis - deep infiltrating endometriosis - laparoscopic neurofunctional pelvic surgery

References

• 1 Possover M, Stöber S, Plaul K, Schneider A. Identification and preservation of the motoric innervation of the bladder in radical hysterectomy type III or IV.  Gynecol Oncol. 2000;  79 154-157
• 2 Possover M, Quakernack J, Chiantera V. The “LANN technique” for reduction of the postoperative functional morbidity in laparoscopic radical pelvic surgery.  J Am Coll Surg. 2005;  201 913-917
• 3 Possover M. Laparoscopic exposure and electrostimulation of the somatic and autonomous pelvic nerves: a new method for implantation of neuroprothesis in paralysed patients?.  J Gynecol Surg Endoscopy Imaging and Allied Techniques. 2004;  1 87-90
• 4 Possover M. Laparoscopic exposure and electrostimulation of the somatic and new method for implantation of neuroprothesis in paralysed patients. J Gynecol Surg Endoscopy Imaging and Allied Techniques.  2004;  1 87-90
• 5 Possover M, Rhiem K, Chiantera V. The “laparoscopic neuro-navigation”- LANN: from a functional cartography of the pelvic autonomous neurosystem to a new field of laparoscopic surgery.  Min Invas Ther & Allied Technol. 2004;  13 362-367
• 6 Possover M, Chiantera V, Baekelandt J. Anatomy of the sacral roots and the pelvic splanclinic nerves in women using the LANN-technique,.  , in press 2007
• 7 Possover M. The “neurologic hypothesis”, a new concept in the pathogenesis of the endometriosis?.  Gynecol Surg Endoscopy Imaging and Allied Technique 2005;  2 107-111
• 8 Amarenco G, Savatosky I, Budet C, Perrigot M. Nevralgies perineales et syndrome du canal c’Alcock.  Ann Urol. 1989;  6 488-492
• 9 Possover M, Quakernack J, Chiantera V. The laparoscopic neurolysis of the pudendal nerve for the therapy of the Alcock's canal syndrome after sacrospinous fixation for vaginal prolaps.  Am J Obstet Gynecol. , in press

1 Disclaimer
No financial support was received for this study and there is no conflict of interest.

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