Laparoscopic nerve-sparing transperitoneal approach for endometriosis infiltrating the pelvic wall and somatic nerves: anatomical considerations and surgical technique.
OBJECTIVE
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.
Ceccaroni
Marcello
M
Gynecologic Oncology Division, Department of Obstetrics and Gynecology, European Gynaecology Endoscopy School, Sacred Heart Hospital "Ospedale Sacro Cuore-Don Calabria", Via Don A. Sempreboni no. 5, 37024, Negrar, Verona, Italy. roberto.clarizia@gmail.com
Clarizia
Roberto
R
Alboni
Carlo
C
Ruffo
Giacomo
G
Bruni
Francesco
F
Roviglione
Giovanni
G
Scioscia
Marco
M
Peters
Inge
I
De Placido
Giuseppe
G
Minelli
Luca
L
D002102:Cadaver; D015331:Cohort Studies; D004210:Dissection; D004715:Endometriosis / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008160:Lumbosacral Plexus / Q000033:anatomy & histology* / Q000601:surgery; D009361:Neoplasm Invasiveness / Q000473:pathology*; D010386:Pelvic Neoplasms / Q000473:pathology / Q000601:surgery*; D010388:Pelvis / Q000033:anatomy & histology / Q000294:innervation; D012187:Retroperitoneal Space; D012584:Sciatic Nerve / Q000033:anatomy & histology; D012680:Sensitivity and Specificity; D013153:Splanchnic Nerves / Q000473:pathology