“Multimodal neurophysiological monitoring during laparoscopic pelvic nerve decompression in deep endometriosis: results from a prospective single-center cohort”

Objective: To describe the technique and assess the clinical utility of intraoperative neurophysiological monitoring (IONM) during laparoscopic pelvic nerve decompression in women with deep endometriosis, with a focus on its integration into surgical workflow and its role in preserving pelvic neurological function.

A prospective descriptive case series was conducted at a Latin American tertiary center between January 2024 and May 2025. Fourteen women with MRI-confirmed deep endometriosis and pelvic nerve involvement underwent laparoscopic decompression assisted by a multimodal IONM protocol. Data on demographics, intraoperative findings, neurophysiological alerts, and clinical symptoms were recorded. Postoperative outcomes were assessed at 1, 3, and 6 months. Descriptive statistics were applied.

A prospective follow-up was conducted in 14 patients, with clinical outcomes evaluated from a minimum of 1 month (92.9%) to up to 6 months (85.7%) postoperatively. All patients exhibited preoperative evidence of nerve compression, most commonly affecting the sciatic (57.1%) and pudendal (50%) nerves. Multimodal intraoperative neurophysiological monitoring (IONM) was successfully implemented in all cases (100%) without any major intraoperative complications. At the 1-month follow-up, 78.6% of patients reported symptom improvement, with sustained clinical benefit observed in 75% at 6 months. No permanent motor deficits were noted, and all transient postoperative symptoms resolved spontaneously. The most frequently improved symptoms included dyschezia, urinary dysfunction, and chronic pelvic pain.

Laparoscopic pelvic nerve decompression with real-time IONM is a safe and reproducible technique that may enhance surgical outcomes and neurological preservation in patients with deep endometriosis. The present study provides foundational evidence for its systematic incorporation in Latin American surgical practice, though larger and controlled studies are warranted to confirm these findings and evaluate long-term efficacy. Article Details The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.

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