Anatomy of the Sacral Roots and the Pelvic Splanchnic Nerves in Women Using the LANN Technique

Marc Possover, Vito Chiàntera, Jan Baekelandt
In: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques · 2007 · vol. 17(6) , pp. 508–510 · doi:10.1097/sle.0b013e31812f81e4 · PMID:18097310 · W2091165221
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Laparoscopic neuro-navigation identified and differentiated sacral nerve roots and pelvic splanchnic nerves, including vesical and rectal fibers, in women undergoing pelvic surgery without complication.

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This study utilized the LAparoscopic Neuro-Navigation (LANN) technique to map and assess the functionality of sacral nerve roots and pelvic splanchnic nerves in 336 women undergoing laparoscopy for pelvic pain or gynecologic conditions. The researchers successfully dissected these nerves lateral to the sacral hypogastric fascia without complications, achieving a mean surgical time of sixteen minutes per side. Key findings demonstrated that the LANN method allows for precise intraoperative functional mapping, enabling clear differentiation between vesical and rectal nerve fibers as well as efferent and afferent pathways. This paper is centrally about endometriosis — specifically, the anatomical mapping relevant to deep infiltrating endometriosis surgery involving pelvic nerve preservation.

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Abstract

AIMS: To report on our anatomic and electrophysiologic findings about the sacral nerve roots and the pelvic splanchnic nerves during laparoscopic pelvic surgery. METHODS: The pelvic splanchnic nerves and the sacral nerve roots were dissected in 336 consecutive patients undergoing laparoscopy for pelvic pain syndrome or gynecologic diseases. Intraoperative assessment of the functionality of the exposed nerves was performed using the LAparoscopic Neuro-Navigation (LANN) technique. RESULTS: Dissection of the sacral roots and the splanchnic pelvic nerves lateral to the sacral hypogastric fascia was feasible without any complications in all patients in this series. The mean surgical time was 16 minutes per side. The pelvic splanchnic nerves could be divided anatomically and functionally into vesical and rectal nerve fibers. CONCLUSIONS: Laparoscopy in combination with the LANN technique not only permits an intraoperative functional mapping of the pelvic motoric autonomous nerves but also a differentiation between the vesical and rectal nerves and between the efferent and afferent pelvic nerves.
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Methods

The pelvic splanchnic nerves and the sacral nerve roots were dissected in 336 consecutive patients undergoing laparoscopy for pelvic pain syndrome or gynecologic diseases. Intraoperative assessment of the functionality of the exposed nerves was performed using the LAparoscopic Neuro-Navigation (LANN) technique.

Results

Dissection of the sacral roots and the splanchnic pelvic nerves lateral to the sacral hypogastric fascia was feasible without any complications in all patients in this series. The mean surgical time was 16 minutes per side. The pelvic splanchnic nerves could be divided anatomically and functionally into vesical and rectal nerve fibers.

Conclusions

Laparoscopy in combination with the LANN technique not only permits an intraoperative functional mapping of the pelvic motoric autonomous nerves but also a differentiation between the vesical and rectal nerves and between the efferent and afferent pelvic nerves.

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