Nerve-sparing techniques in deeply infiltrating endometriosis: a narrative review

Lacey C Brennan, Brennan LC, Sarah Shamiya, Shamiya S, Jade Desilets, Lemos N, Nucelio Lemos
Minerva obstetrics and gynecology · 2026 · vol. 78(3) , pp. 261–274 · doi:10.23736/s2724-606x.25.05808-7 · PMID:41631777 · W7127274781
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This review details the evolution of nerve-sparing surgical techniques for deeply infiltrating endometriosis, focusing on anatomical precision and functional preservation to improve patient outcomes.

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Abstract

Nerve-sparing gynecologic surgery has evolved as a critical advancement in the management of deeply infiltrating endometriosis, aiming to reduce postoperative dysfunction while preserving surgical efficacy. Historically, procedures such as radical hysterectomy and excision of deeply infiltrating endometriosis carried high risks of urinary, bowel, and sexual dysfunction due to inadvertent injury to pelvic autonomic nerves. Recent developments in pelvic neuroanatomy, enhanced laparoscopic visualization, and operative technique have enabled surgeons to identify and preserve key neural structures during dissection. This review traces the evolution of nerve-sparing surgery, from early radical oncologic techniques to contemporary minimally invasive approaches guided by functional anatomy. We highlight contributions from key innovators and describe standardized terminology for pelvic nerves, fasciae, and retroperitoneal spaces, which aim to improve surgical reproducibility. Surgical techniques including the laparoscopic neuronavigation technique, the Negrar Method, and hypogastric nerve-based dissection are presented in detail, emphasizing both neuroanatomical precision and practical application. The use of anatomical landmarks in settings without advanced equipment is also discussed. Special attention is given to bowel surgery in endometriosis, balancing radicality with preservation of pelvic nerve function. Collectively, these strategies underscore a shift toward personalized, anatomy-guided surgery that prioritizes both disease control and long-term quality of life. As interest in nerve-sparing approaches continues to grow, education, multidisciplinary collaboration, and ongoing refinement of surgical methods will be essential to broadening access and improving patient outcomes for patients with deeply infiltrating endometriosis.
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JOURNAL TOOLS | | Journal policies | | Publishing options | | eTOC | | To subscribe | | Submit an article | | Recommend to your librarian | ARTICLE TOOLS | | Publication history | | Reprints | | Permissions | | Cite this article as | | Share | YOUR ACCOUNT YOUR ORDERS SHOPPING BASKET Items: 0 Total amount: € 0,00 HOW TO ORDER YOUR SUBSCRIPTIONS YOUR ARTICLES YOUR EBOOKS COUPON ACCESSIBILITY REVIEW Open access Minerva Obstetrics and Gynecology 2026 June;78(3):261-74 DOI: 10.23736/S2724-606X.25.05808-7 Copyright © 2025 THE AUTHORS This is an open access article distributed under the terms of the CC BY-NC 4.0 license which allows users to distribute, remix, adapt and build upon the manuscript, as long as this is not done for commercial purposes, the user gives appropriate credits to the original author(s) and the source (with a link to the formal publication through the relevant DOI), provides a link to the license and indicates if changes were made. language: English Nerve-sparing techniques in deeply infiltrating endometriosis: a narrative review Lacey C. BRENNAN 1, 2 ✉, Sarah SHAMIYA 3, 4, 5, Jade DESILETS 3, 4, 5, Nucelio LEMOS 3, 4, 5, 6, 7 1 Department of Obstetrics and Gynecology, Peter Lougheed Centre, Calgary, AB, Canada; 2 Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada; 3 Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, ON, Canada; 4 Department of Obstetrics and Gynecology, Women’s College Hospital, Toronto, ON, Canada; 5 Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada; 6 Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil; 7 Institute for Care and Rehabilitation in Neuropelveology and Gynecology, São Paulo, Brazil Nerve-sparing gynecologic surgery has evolved as a critical advancement in the management of deeply infiltrating endometriosis, aiming to reduce postoperative dysfunction while preserving surgical efficacy. Historically, procedures such as radical hysterectomy and excision of deeply infiltrating endometriosis carried high risks of urinary, bowel, and sexual dysfunction due to inadvertent injury to pelvic autonomic nerves. Recent developments in pelvic neuroanatomy, enhanced laparoscopic visualization, and operative technique have enabled surgeons to identify and preserve key neural structures during dissection. This review traces the evolution of nerve-sparing surgery, from early radical oncologic techniques to contemporary minimally invasive approaches guided by functional anatomy. We highlight contributions from key innovators and describe standardized terminology for pelvic nerves, fasciae, and retroperitoneal spaces, which aim to improve surgical reproducibility. Surgical techniques including the laparoscopic neuronavigation technique, the Negrar Method, and hypogastric nerve-based dissection are presented in detail, emphasizing both neuroanatomical precision and practical application. The use of anatomical landmarks in settings without advanced equipment is also discussed. Special attention is given to bowel surgery in endometriosis, balancing radicality with preservation of pelvic nerve function. Collectively, these strategies underscore a shift toward personalized, anatomy-guided surgery that prioritizes both disease control and long-term quality of life. As interest in nerve-sparing approaches continues to grow, education, multidisciplinary collaboration, and ongoing refinement of surgical methods will be essential to broadening access and improving patient outcomes for patients with deeply infiltrating endometriosis. KEY WORDS: Laparoscopy; Endometriosis; Gynecologic surgical procedures

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (56)

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