{"paper_id":"7c03cd10-f2ab-4524-ba35-57c6bd0d4b11","body_text":"Abstract\nPurpose\nEndometriotic or fibrotic involvement of sacral plexus and pudendal and sciatic nerves may be quite frequently the endopelvic cause of ano-genital and pelvic pain. Feasibility of a laparoscopic transperitoneal approach to the somatic nerves of the pelvis was determined and showed by Possover et al. for diagnosis and treatment of ano-genital pain caused by pudendal and/or sacral nerve roots lesions and adopted at our institution. In this paper we report our experience and anatomo-surgical consideration regarding this technique.\nMethods\nConfidence with this technique was obtained after several laparoscopic and laparotomic dissections on fresh, embalmed and formalin-fixed female cadavers and is now routinely performed at our institution in all cases of extensive endometriosis of the pelvic wall, involving the somatic nerves.\nResults\nWe describe two different laparoscopic transperitoneal approaches to the lateral pelvic wall in case of: (A) deep pelvic endometriosis with rectal and/or parametrial involvement extending to pelvic wall and somatic nerves; (B) isolated endometriosis of pelvic wall and somatic nerves.\nConclusions\nLaparoscopic transperitoneal retroperitoneal nerve-sparing approach to the pelvic wall proved to be a feasible and useful procedure even if limited to referred laparoscopic centers and anatomically experienced and skilled surgeons.\nSimilar content being viewed by others\nReferences\nCeccaroni M, Fanfani F, Ercoli A, Scambia G (2006) Innervazione viscerale e somatica della pelvi femminile.Testo-Atlante di anatomia chirurgica. CIC editore\nCeccaroni M, Fanfani F, Ercoli A et al (2007) Nerve-sparing radical hysterectomy: an anatomical evaluation of the risk of autonomic nerves injury during parametrial dissection. Proceedings of the “International Symposium on radical hysterectomy, dedicated to Hidekazu Okabayashi”, Kyoto, P11, 155\nCeccaroni M, Fanfani F, Ercoli A et al (2007) Nerve-sparing radical hysterectomy: an anatomical evaluation of middle rectal artery and deep uterine vein as surgical landmarks during parametrial dissection. Proceedings of the international symposium on radical hysterectomy, dedicated to Hidekazu Okabayashi, Kyoto, P12, 155\nCeccaroni M, Fanfani F, Ercoli A et al (2007) Anatomo-surgical principles and feasibility for a true Type III laparoscopic nerve-sparing radical hysterectomy. Proceedings of the international symposium on radical hysterectomy, dedicated to Hidekazu Okabayashi, Kyoto, 89\nCeccaroni M, Scioscia M, Ruffo G et al (2009) Nerve-sparing laparoscopic complete excision of deep endometriosis with rectal resection: comparison with the classical technique. Ann Agricult Environ Med (in press)\nCeccaroni M, Pontrelli G, Scioscia M et al (2010) Nerve-sparing laparoscopic radical excision of deep endometriosis with rectal and parametrial resection. J Minim Invasive Gynecol (in press)\nErcoli A, Delmas V, Fanfani F, Gadonneix P, Ceccaroni M, Fagotti A, Mancuso S, Scambia G (2005) Terminologia Anatomica versus unofficial descriptions and nomenclature of the fasciae and ligaments of the female pelvis: a dissection-based comparative study. Am J Obstet Gynecol 193:1565–1573\nHeald RJ (1988) The ‘Holy Plane’ of rectal surgery. J R Soc Med 81:503–508\nLandi S, Ceccaroni M, Perutelli A et al (2006) Laparoscopic nerve-sparing complete excision of deep endometriosis: is it feasible? Hum Reprod 21:774–781\nNehme-Schuster H, Youssef C, Roy C, Brettes JP, Martin T, Pasquali JL, Korganow AS (2005) Alcock’s canal syndrome revealing endometriosis. Lancet 366:1238\nPossover M, Chiantera V (2007) Isolated infiltrative endometriosis of the sciatic nerve: a report of three patients. Fertil Steril 87:417.e17–19\nPossover M, Baekelandt J, Flaskamp C, Li D et al (2007) Laparoscopic neurolysis of the sacral plexus and the sciatic nerve for extensive endometriosis of the pelvic wall. Minim Invasive Neurosurg 50:33–36\nPossover M (2009) Laparoscopic management of endopelvic etiologies of pudendal pain in 134 consecutive patients. J Urol 181:1732–1736\nRobert R, Labat JJ, Bensignor Glemain P, Deschamps C, Raoul C, Hamel O (2005) Decompression and transposition of the pudendal nerve in pudendal neuralgia: a randomized controlled trial and long-term evaluation. Eur Urol 47:403\nWaldeyer W (1899) Das Becken. Cohen, Bonn\nYabuki Y, Asamoto A, Hoshiba T et al (2000) Radical hysterectomy: an anatomic evaluation of parametrial dissection. Gynecol Oncol 77:155–163\nAuthor information\nAuthors and Affiliations\nCorresponding author\nRights and permissions\nAbout this article\nCite this article\nCeccaroni, M., Clarizia, R., Alboni, C. et al. Laparoscopic nerve-sparing transperitoneal approach for endometriosis infiltrating the pelvic wall and somatic nerves: anatomical considerations and surgical technique. Surg Radiol Anat 32, 601–604 (2010). https://doi.org/10.1007/s00276-010-0624-6\nReceived:\nAccepted:\nPublished:\nIssue date:\nDOI: https://doi.org/10.1007/s00276-010-0624-6","source_license":"CC0","license_restricted":false}