Minimally invasive surgery in pelvic pain: from a gynecological perspective

Due to the multifactorial etiology of CPP, its diagnosis and management is challenging in clinical practice. CPP can be caused by gynecological, gastrointestinal, urological, musculoskeletal and psychological conditions. Therefore, a multidisciplinary management and if possible in specialized centers is recommended. Nowadays, with the advances in minimal invasive surgical techniques and with the introduction of new approaches such as neuropelveology more patients receive a successful diagnosis and treatment. Even in complicated operations such as DIE surgeries, both conventional laparoscopy and robot-assisted laparoscopy have replaced laparotomy. As the understanding of pelvic neurophysiology advances nerve sparing surgeries with minimal invasive techniques are replacing neuroablative procedures with better outcomes. Thus, minimal invasive surgery is now the gold standard in surgical treatment of CPP. However, despite of all these advances recurrence and persistence of pain postoperatively should always be kept in mind. Therefore, a multidisciplinary preoperative evaluation is always emphasized for better outcomes. In Table 3, the take-home messages of this review can be seen. Full table Acknowledgments Funding: None. Footnote Provenance and Peer Review: This article was commissioned by the Guest Editor (Gokhan Kilic) for the series “Minimally Invasive Treatment Modalities for Female Pelvic Floor Disorders” published in Gynecology and Pelvic Medicine. The article has undergone external peer review. Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://gpm.amegroups.org/article/view/10.21037/gpm-2020-pfd-04/coif). The series “Minimally Invasive Treatment Modalities for Female Pelvic Floor Disorders” was commissioned by the editorial office without any funding or sponsorship. The authors have no other conflicts of interest to declare. Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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