Laparoscopic nerve-sparing transperitoneal approach for endometriosis infiltrating the pelvic wall and somatic nerves: anatomical considerations and surgical technique

Marcello Ceccaroni, Roberto Clarizia, Clarizia R, Carlo Alboni, Alboni C, Ruffo G, Giacomo Ruffo, Bruni F, Francesco Bruni, Roviglione G, Giovanni Roviglione, Scioscia M, Marco Scioscia, Inge Peters, Giuseppe De Placido, De Placido G, Minelli L, Luca Minelli
Surgical and radiologic anatomy : SRA · 2010 · vol. 32(6) , pp. 601–604 · doi:10.1007/s00276-010-0624-6 · PMID:20087591 · W1988735292
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⚙ AI-generated summary by gemini-2.5-flash-lite+body, 2026-06-13 ⓘ

This paper describes the feasibility and surgical technique of a laparoscopic transperitoneal approach to treat pelvic wall endometriosis involving somatic nerves.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-13 · read from full text ⓘ

The paper describes a laparoscopic nerve-sparing transperitoneal approach for endometriosis infiltrating the lateral pelvic wall with involvement of pelvic wall somatic nerves, including the pudendal and sciatic-related structures, based on anatomical considerations. Methods included developing confidence through multiple laparoscopic and laparotomic dissections on fresh, embalmed, and formalin-fixed female cadavers, after which the technique was routinely performed for extensive endometriosis of the pelvic wall involving somatic nerves at the authors’ institution. The authors report two laparoscopic transperitoneal approaches tailored to (A) deep pelvic endometriosis with rectal/parametrial extension to pelvic wall and somatic nerves, and (B) isolated pelvic wall endometriosis of somatic nerves, concluding that the nerve-sparing procedure is feasible and useful in experienced centers. The paper does not explicitly provide patient outcome data and is limited to anatomical feasibility/technique description. This paper is centrally about endometriosis — specifically a nerve-sparing laparoscopic transperitoneal surgical technique for endometriosis infiltrating the pelvic wall and somatic nerves.

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Abstract

PurposeEndometriotic 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.MethodsConfidence 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.ResultsWe 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.ConclusionsLaparoscopic 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.
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Abstract

Purpose Endometriotic 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.

Methods

Confidence 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.

Results

We 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.

Conclusions

Laparoscopic 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. Similar content being viewed by others

References

Ceccaroni M, Fanfani F, Ercoli A, Scambia G (2006) Innervazione viscerale e somatica della pelvi femminile.Testo-Atlante di anatomia chirurgica. CIC editore Ceccaroni 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 Ceccaroni 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 Ceccaroni 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 Ceccaroni 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) Ceccaroni 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) Ercoli 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 Heald RJ (1988) The ‘Holy Plane’ of rectal surgery. J R Soc Med 81:503–508 Landi S, Ceccaroni M, Perutelli A et al (2006) Laparoscopic nerve-sparing complete excision of deep endometriosis: is it feasible? Hum Reprod 21:774–781 Nehme-Schuster H, Youssef C, Roy C, Brettes JP, Martin T, Pasquali JL, Korganow AS (2005) Alcock’s canal syndrome revealing endometriosis. Lancet 366:1238 Possover M, Chiantera V (2007) Isolated infiltrative endometriosis of the sciatic nerve: a report of three patients. Fertil Steril 87:417.e17–19 Possover 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 Possover M (2009) Laparoscopic management of endopelvic etiologies of pudendal pain in 134 consecutive patients. J Urol 181:1732–1736 Robert 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 Waldeyer W (1899) Das Becken. Cohen, Bonn Yabuki Y, Asamoto A, Hoshiba T et al (2000) Radical hysterectomy: an anatomic evaluation of parametrial dissection. Gynecol Oncol 77:155–163 Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Ceccaroni, 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 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00276-010-0624-6

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Laparoscopy Lumbosacral Plexus Neoplasm Invasiveness Pelvic Neoplasms Cadaver Cohort Studies Dissection Endometriosis Endometriosis Feasibility Studies Female Humans Laparoscopy Lumbosacral Plexus Lumbosacral Plexus Neoplasm Invasiveness Pelvic Neoplasms Pelvic Neoplasms Pelvis

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