Laparoscopic neurolysis of the sacral plexus and the sciatic nerve for extensive endometriosis of the pelvic wall

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…

The laparoscopic implantation of neuroprothesis (LION) procedure to control intractable abdomino-pelvic neuralgia

Objective. To present different aspects and advantages of the laparoscopic implantation of a peripheral nerve stimulator adjacent to the pelvic nerves, aimed at treating intractable pelvic neuralgia by means of neuromodulation - the laparoscopic implantation of neuroprothesis (LION) procedure. Materials and Methods. We report here a series of three patients with different types and etiologies of chronic pelvic neuralgia who underwent laparoscopy for implantation of a peripheral nerve stimulator for neuromodulation, the first for neuromodulation of the ilioinguinal and pudendal nerves, the second for neuromodulation of the sciatic nerve, and the third for neuromodulation of the sacral nerve …

Anatomy of the Sacral Roots and the Pelvic Splanchnic Nerves in Women Using the LANN Technique

AIMS: To report on our anatomic and electrophysiologic findings about the sacral nerve roots and the pelvic splanchnic nerves during laparoscopic pelvic surgery. METHODS: The pelvic splanchnic nerves and the sacral nerve roots were dissected in 336 consecutive patients undergoing laparoscopy for pelvic pain syndrome or gynecologic diseases. Intraoperative assessment of the functionality of the exposed nerves was performed using the LAparoscopic Neuro-Navigation (LANN) technique. RESULTS: Dissection of the sacral roots and the splanchnic pelvic nerves lateral to the sacral hypogastric fascia was feasible without any complications in all patients in this series. The mean surgical time was 16 …

The LANN technique to reduce postoperative functional morbidity in laparoscopic radical pelvic surgery

BACKGROUND: We investigated the feasibility and advantages of introducing Laparoscopic Neuro-Navigation (LANN) into the field of laparoscopic gynecologic radical pelvic surgery. STUDY DESIGN: In a prospective pilot study, 261 consecutive patients underwent laparoscopic radical pelvic surgery for cervical cancer or deep infiltrating endometriosis of the parametria. During the procedure, dissection and electrostimulation, and consequently, sparing of the pelvic parasympathetic nerves by transection of the parametria, were performed. Postoperative bladder dysfunction was documented. RESULTS: Laparoscopic dissection and electrostimulation of the pelvic splanchnic nerves were feasible in all pat…

The Laparoscopic Approach to Control Intractable Pelvic Neuralgia: From Laparoscopic Pelvic Neurosurgery to the LION Procedure

OBJECTIVE: To present different aspects and advantages of the laparoscopic approach to the pelvic nerves aimed at treating intractable pelvic neuralgia. METHODS: We report on a nonconsecutive series of 7 patients with different types and etiologies of chronic pelvic neuralgia, all of whom underwent laparoscopy. In all 7 cases, the neuralgia was refractory to medical management and had profound socioeconomic consequences for the patients. RESULTS: Techniques of laparoscopic transperitoneal neurolysis of several pelvic somatic nerves are described but also our technique of laparoscopic implantation of neuroprothesis for neuromodulation on somatic pelvic nerves or on autonomic pelvic nerves as…

The "Laparoscopic Neuro-Navigation" -- LANN: from a functional cartography of the pelvic autonomous neurosystem to a new field of laparoscopic surgery

It is the objective of this study to etablish the technique of laparoscopic exposure of all pelvic somatic and autonomous nerves. In all our patients who underwent a laparoscopic surgical approach of the retroperitoneum, exposure and assessment of the exposed nerves using laparoscopic neuro-navigation were performed. Laparoscopic surgery allows the surgical approach to all pelvic nerves, particularly to the sciatic nerve, the pudendal nerve and the splanchnic pelvic nerves. We describe a cartography of the functional anatomy of the pelvic plexus and elaborate on the concept of "laparoscopic pelvic functional surgery". © 2004 Taylor & Francis.

Isolated infiltrative endometriosis of the sciatic nerve: a report of three patients.

Objective: To report that isolated endometriosis of the sciatic nerve without further manifestation of endometriosis does exist. Design: We describe our technique of laparoscopic neurolysis of the sciatic nerve and the sacral plexus. Setting: Department of Gynecology and Obstetrics, St. Elisabeth Hospital, affiliated with the University of Cologne, Cologne, Germany. Patient(s): Three female patients with isolated endometriotic infiltration of the endopelvic portion of the sciatic nerve. Intervention(s): Elective laparoscopic neurolysis of the sciatic nerve with removal of endometriosis. Main Outcome Measure(s): Disparition of pain in the patients and histologic information of the endometrio…

Neuromodulation of the superior hypogastric plexus: a new option to treat bladder atonia secondary to radical pelvic surgery?

Abstract Background The aim of this study is to report on the impact of neuromodulation to the superior hypogastric plexus in patients with bladder atonia secondary to pelvic surgery. Methods In 4 consecutive patients with bladder atonia secondary to pelvic surgery, we performed a laparoscopic implantation of a neurostimulator—LION procedure—to the entire superior hypogastric plexus. Results Of the 4 reported patients, 3 are able to partially void or empty their bladder. Conclusions If the presented results could be obtained in further patients and maintained in long-term follow-up, the LION procedure to the superior hypogastric plexus could change the management of bladder function in pati…

Laparoscopic endopelvic sacral implantation of a Brindley controller for recovery of bladder function in a paralyzed patient

Background: A number of techniques are being investigated to accomplish bladder control recovery in paralyzed patients using the neurostimulation, but currently, all techniques are based on the dorsal implantation of the electrodes using a laminectomy. Methods: On 27 April 2006 we performed a laparoscopic implantation of a Finetech-Brindley bladder controller on the endopelvic sacral roots in a Th8 completely paralyzed woman who had previously undergone the removal of a Brindley controller due to an arachnoiditis after extrathecal implantation with intradural sacral deafferentation. Results: We required about 3.5 h for the entire surgical procedure; no complications occurred and the patient…

The "neurologic hypothesis": A new concept in the pathogenesis of the endometriosis?

To cartograph the retroperitoneal infiltration of deep-infiltrating endometriosis of the rectovaginal space, we report on 467 patients who underwent laparoscopic/vaginal surgery for deep-infiltrating adenomyosis of the rectovaginal space. Exact localisation of the locoregional extension and of secondary infiltrating localisation where noted. The cervix and the rectovaginal ligament were mostly involved, while isolated lesions of the rectovaginal space were very rare. Comparisons of the most involved sites show an absolute correlation with the anatomical repartition of the pelvic sympathetic nervous system. We postulate a new "neurologic theory" which could be one more explanation for the de…

Neuropelveology: New Groundbreaking Discipline in Medicine