Laparoscopic Neurolysis of the Sacral Plexus and the Sciatic Nerve for Extensive Endometriosis of the Pelvic Wall

M Possover, Possover M, Marc Possover, Jan Baekelandt, J Baekelandt, Baekelandt J, Flaskamp C, C Flaskamp, Li D, D Li, V Chiantera, Vito Chiàntera
Minimally invasive neurosurgery : MIN · 2007 · vol. 50(1) , pp. 33–36 · doi:10.1055/s-2007-970075 · PMID:17546541 · W2001968345
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⚙ AI-generated summary by claude@2026-06, 2026-06-09 ⓘ

This study reports the feasibility of laparoscopic neurolysis of the sacral plexus and sciatic nerve for endometriosis of the pelvic wall in 21 patients.

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⚙ AI-generated deep summary by claude@2026-07, 2026-07-09 · read from full text ⓘ

This paper reports the feasibility of laparoscopic neurolysis of the sacral plexus and sciatic nerve using a transperitoneal approach combined with the LANN technique for intraoperative nerve function assessment in 21 young patients with deep endometriotic infiltration of the lateral pelvic wall. The authors describe exposure and resection of endometriotic lesions while sparing somatic nerves, aiming to reduce functional morbidity by preserving nerve function guided by the technique. A stated limitation is that their experience is limited to a short series, and the work is framed primarily as feasible for trained laparoscopic surgeons with retroperitoneal pelvic (neuro)anatomy knowledge. This paper is centrally about endometriosis — it reports laparoscopic neurolysis for deep infiltrating endometriosis involving the sacral plexus and sciatic nerve.

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Abstract

BACKGROUND: The aim of this study is to report on the feasibility of laparoscopic neurolysis of the plexus sacralis and the sciatic nerve in deep endometriotic infiltration of the lateral pelvic wall. METHODS: A transperitoneal approach to the pelvic nerves combined with the LANN technique for intraoperative assessment of the function of the exposed nerves permit exposure and sparing of all somatic nerves during resection of the endometriotic lesion. RESULTS: We report on our short experience with 21 patients who underwent this technique for the treatment of endometriotic infiltration of the sacral plexus at different levels. CONCLUSION: In young patients with chronic unilateral sciatica or unilateral pudendal neuralgia - Alcock's canal syndrome - where no neurological/orthopedic etiologies have been found, endometriotic infiltration of the lateral pelvic wall has to be implicated as a potential etiology and an indication for laparoscopy must be discussed. Laparoscopic neurolysis of the pelvic somatic nerves is a feasible procedure for trained laparoscopic surgeons who have a good knowledge of the retroperitoneal pelvic (neuro)anatomy.
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Abstract

Background: The aim of this study is to report on the feasibility of laparoscopic neurolysis of the plexus sacralis and the sciatic nerve in deep endometriotic infiltration of the lateral pelvic wall.

Methods

A transperitoneal approach to the pelvic nerves combined with the LANN technique for intraoperative assessment of the function of the exposed nerves permit exposure and sparing of all somatic nerves during resection of the endometriotic lesion.

Results

We report on our short experience with 21 patients who underwent this technique for the treatment of endometriotic infiltration of the sacral plexus at different levels.

Conclusion

In young patients with chronic unilateral sciatica or unilateral pudendal neuralgia - Alcock's canal syndrome - where no neurological/orthopedic etiologies have been found, endometriotic infiltration of the lateral pelvic wall has to be implicated as a potential etiology and an indication for laparoscopy must be discussed. Laparoscopic neurolysis of the pelvic somatic nerves is a feasible procedure for trained laparoscopic surgeons who have a good knowledge of the retroperitoneal pelvic (neuro)anatomy. Key words Somatic pelvic nerve - laparoscopic neurolysis - deep infiltrating endometriosis - laparoscopic neurofunctional pelvic surgery

References

- 1 Possover M, Stöber S, Plaul K, Schneider A. Identification and preservation of the motoric innervation of the bladder in radical hysterectomy type III or IV. Gynecol Oncol. 2000; 79 154-157 - 2 Possover M, Quakernack J, Chiantera V. The “LANN technique” for reduction of the postoperative functional morbidity in laparoscopic radical pelvic surgery. J Am Coll Surg. 2005; 201 913-917 - 3 Possover M. Laparoscopic exposure and electrostimulation of the somatic and autonomous pelvic nerves: a new method for implantation of neuroprothesis in paralysed patients?. J Gynecol Surg Endoscopy Imaging and Allied Techniques. 2004; 1 87-90 - 4 Possover M. Laparoscopic exposure and electrostimulation of the somatic and new method for implantation of neuroprothesis in paralysed patients. J Gynecol Surg Endoscopy Imaging and Allied Techniques. 2004; 1 87-90 - 5 Possover M, Rhiem K, Chiantera V. The “laparoscopic neuro-navigation”- LANN: from a functional cartography of the pelvic autonomous neurosystem to a new field of laparoscopic surgery. Min Invas Ther & Allied Technol. 2004; 13 362-367 - 6 Possover M, Chiantera V, Baekelandt J. Anatomy of the sacral roots and the pelvic splanclinic nerves in women using the LANN-technique,. , in press 2007 - 7 Possover M. The “neurologic hypothesis”, a new concept in the pathogenesis of the endometriosis?. Gynecol Surg Endoscopy Imaging and Allied Technique 2005; 2 107-111 - 8 Amarenco G, Savatosky I, Budet C, Perrigot M. Nevralgies perineales et syndrome du canal c’Alcock. Ann Urol. 1989; 6 488-492 - 9 Possover M, Quakernack J, Chiantera V. The laparoscopic neurolysis of the pudendal nerve for the therapy of the Alcock's canal syndrome after sacrospinous fixation for vaginal prolaps. Am J Obstet Gynecol. , in press 1 Disclaimer No financial support was received for this study and there is no conflict of interest. Correspondence Prof.Dr. M. Possover Department of Obstetrics and Gynecology and Laparoscopic Neurofunctional Pelvic Surgery St. Elisabeth Hospital - Training Center of the ISPS Werthmannstraße 1 50935 Cologne Germany Phone: +49/221/4677/13 01 Fax: +49/221/4677/13 09 Email: [email protected]

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Laparoscopy Lumbosacral Plexus Sciatic Nerve Endometriosis Female Humans Laparoscopy Lumbosacral Plexus Pelvis Pelvis Sciatic Nerve

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.

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