title: New laparoscopic approach to the pudendal nerve for neuromodulation based on an anatomic study.
abstract: The aim was to develop a new laparoscopic technique for placement of a pudendal lead.
  
  
  
  Development of a direct, feasible and reliable minimal-invasive laparoscopic approach to the pudendal nerve (PN). Thirty-one embalmed human specimens were dissected for the relevant anatomic structures of the pelvis. Step-by-step documentation and analysis of the laparoscopic approach in order to locate the PN directly in its course around the medial part of the sacrospinous ligament and test this approach for feasibility. Landmarks for intraoperative navigation towards the PN as well as the possible position of an lead were selected and demonstrated.
  
  
  
  The visible medial umbilical fold, the intrapelvine part of the internal pudendal artery, the coccygeus muscle and the sacrospinous ligament are the main landmarks. The PN traverses the medial part of the sacrospinous ligament dorsally, medially to the internal pudendal artery. The medial part of the sacrospinous ligament has to be exposed in order to display the nerve. An lead can be placed ventrally on the nerve or around it, depending on the lead type or shape.
  
  
  
  A precise and reliable identification of the PN by means of laparoscopy is feasible with an easy four-step approach: (1) identification of the medial umbilical fold; (2) identification of the internal iliac artery; (3) identification of the internal pudendal artery and incision of the coccygeus muscle ('white line', arcuated line); and (4) exposition of the medial part of the sacrospinous ligament to display the PN.
authors.affiliation: Division for Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Tirol, Austria.
authors.forename: Marko
authors.initials: M
authors.lastname: Konschake
authors.affiliation: Division for Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Tirol, Austria.
authors.forename: Erich
authors.initials: E
authors.lastname: Brenner
authors.affiliation: Division for Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Tirol, Austria.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Moriggl
authors.affiliation: Division for Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Tirol, Austria.
authors.forename: Romed
authors.initials: R
authors.lastname: Hörmann
authors.affiliation: Department of Urology and Andrology, SALK University Clinic and Paracelsus Private Medical University, Salzburg, Austria.
authors.forename: Sophina
authors.initials: S
authors.lastname: Bauer
authors.affiliation: Department of Urology and Andrology, SALK University Clinic and Paracelsus Private Medical University, Salzburg, Austria.
authors.forename: Esra
authors.initials: E
authors.lastname: Foditsch
authors.affiliation: Department of Urology and Andrology, SALK University Clinic and Paracelsus Private Medical University, Salzburg, Austria.
authors.forename: Günther
authors.initials: G
authors.lastname: Janetschek
authors.affiliation: Division for Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Tirol, Austria.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Künzel
authors.affiliation: Department of Urology and Andrology, SALK University Clinic and Paracelsus Private Medical University, Salzburg, Austria.
authors.forename: Karl-Dietrich
authors.initials: KD
authors.lastname: Sievert
authors.affiliation: Department of Urology and Andrology, SALK University Clinic and Paracelsus Private Medical University, Salzburg, Austria.
authors.forename: Reinhold
authors.initials: R
authors.lastname: Zimmermann
mesh_terms: D002102:Cadaver; D004599:Electric Stimulation Therapy; D004567:Electrodes, Implanted; D005240:Feasibility Studies; D006801:Humans; D010535:Laparoscopy; D010388:Pelvis / Q000033:anatomy & histology / Q000601:surgery; D019919:Prosthesis Implantation / Q000379:methods*; D060525:Pudendal Nerve / Q000033:anatomy & histology / Q000601:surgery*
keywords: internal pudendal artery; laparoscopic approach; medial umbilical fold; neuromodulation; pudendal nerve; sacrospinous ligament