Laparoscopic identification of pelvic nerves in patients with deep infiltrating endometriosis

E Volpi, Eugenio Volpi, Volpi E, A Ferrero, Annamaria Ferrero, P Sismondi, Sismondi P
Surgical endoscopy · 2004 · vol. 18(7) , pp. 1109–1112 · doi:10.1007/s00464-003-9115-8 · PMID:15156387 · W2158142328
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⚙ AI-generated summary by gemini-2.5-flash-lite+body, 2026-06-09 ⓘ

Laparoscopic visualization of pelvic nerves was possible in most deep endometriosis patients, but nerve resection, especially bilateral, was associated with significant urinary retention.

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⚙ AI-generated deep summary by claude@2026-07, 2026-07-10 · read from full text ⓘ

This study evaluated laparoscopic visualization and, when needed, resection of posterior pelvic nerves (inferior hypogastric and splanchnic nerves) in 24 patients undergoing surgery for deep infiltrating endometriosis, assessing intraoperative findings and videotaped procedures. The authors reported that inferior hypogastric nerves could be visualized in 20 of 22 patients (90.1%), and that nerve resection occurred in 8 patients (33.3%), alongside uterosacral ligament resections in a subset. As an objective outcome criterion, urinary retention after surgery was compared with the extent of nerve resection on video review, with 7 of 8 patients who had nerve resection experiencing urinary retention requiring self-catheterization (median time to resume voiding: 18 days). The paper’s main limitation is its small, single-cohort observational design without a detailed non-resection comparison beyond the videotape-based comparisons. This paper is centrally about endometriosis — it focuses on laparoscopic identification and nerve-sparing nerve resection implications during surgery for deep infiltrating endometriosis.

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Abstract

BackgroundNerve sparing is suggested for cancer surgery, but no experience is available for deep endometriosis. The aim of this study was to laparoscopically identify the pelvic nerves in the posterior pelvis.MethodsA total of 24 patients operated for deep endometriosis were considered. During surgery and on videotapes of the procedures, we evaluated single- or double-sided resection of the uterosacral ligaments and other structure's visualization of the inferior hypogastric and the splanchnic nerves. The most important objective criteria for resection of the nerves was urinary retention after surgery, which was compared to surgical resection on the videotapes.ResultsVisualization of the inferior hypogastric nerves was possible in 20 of 22 patients (90.1%). Eight of the 24 patients had at least one inferior hypogastric nerve resected (33.3%). In seven patients (29.2%) resection of the uterosacral ligaments was bilateral, and in three of these the nerves were resected. Postoperatively, the median residual urine volume after the first spontaneous voiding was 40 ml (range, 20-400). Seven of eight patients (29.2%) with resection of the nerves had urinary retention and self-catheterization at discharge. The difference in urinary residuum after first voiding between patients undergoing self-catheterization and patients released without the catheter was significant ( p < 0.01). The median time to resume the voiding function in patients with self-catheterization was 18 days (range, 9-45).ConclusionsNerve visualization is possible by means of laparoscopic surgery for deep endometriosis in a high rate of patients. Careful technique is necessary, but the laparoscopic approach may help. Even single-sided radical dissection can induce important urinary retention.
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Abstract

Background Nerve sparing is suggested for cancer surgery, but no experience is available for deep endometriosis. The aim of this study was to laparoscopically identify the pelvic nerves in the posterior pelvis.

Methods

A total of 24 patients operated for deep endometriosis were considered. During surgery and on videotapes of the procedures, we evaluated single- or double-sided resection of the uterosacral ligaments and other structure’s visualization of the inferior hypogastric and the splanchnic nerves. The most important objective criteria for resection of the nerves was urinary retention after surgery, which was compared to surgical resection on the videotapes.

Results

Visualization of the inferior hypogastric nerves was possible in 20 of 22 patients (90.1%). Eight of the 24 patients had at least one inferior hypogastric nerve resected (33.3%). In seven patients (29.2%) resection of the uterosacral ligaments was bilateral, and in three of these the nerves were resected. Postoperatively, the median residual urine volume after the first spontaneous voiding was 40 ml (range, 20–400). Seven of eight patients (29.2%) with resection of the nerves had urinary retention and self-catheterization at discharge. The difference in urinary residuum after first voiding between patients undergoing self-catheterization and patients released without the catheter was significant (p < 0.01). The median time to resume the voiding function in patients with self-catheterization was 18 days (range, 9–45).

Conclusions

Nerve visualization is possible by means of laparoscopic surgery for deep endometriosis in a high rate of patients. Careful technique is necessary, but the laparoscopic approach may help. Even single-sided radical dissection can induce important urinary retention. Similar content being viewed by others

References

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Gynecol Oncol 62 370–378 Occurrence Handle10.1006/gyno.1996.0251 Occurrence Handle1:STN:280:BymH38jktFQ%3D Occurrence Handle8812535 Acknowledgments We are greatly indebted to A. Schneider, M. Possover, and J.B. Trimbos, who at different times showed us and discussed with us the anatomy of the nerves. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Volpi, E., Ferrero, A. & Sismondi, P. Laparoscopic identification of pelvic nerves in patients with deep infiltrating endometriosis. Surg Endosc 18, 1109–1112 (2004). https://doi.org/10.1007/s00464-003-9115-8 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00464-003-9115-8

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Condition tags

endometriosisdie_deep_infiltrating

MeSH descriptors

Endometriosis Hypogastric Plexus Laparoscopy Postoperative Complications Splanchnic Nerves Urinary Retention Adult Broad Ligament Broad Ligament Broad Ligament Broad Ligament Endometriosis Endometriosis Female Humans Hypogastric Plexus Hypogastric Plexus Intraoperative Complications Intraoperative Complications Postoperative Complications

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