Laparoscopic Pudendal Nerve Decompression
Laparoscopic Pudendal Nerve decompression is a novel technique employed in the treatment of severe Pudendal Neuralgia, a type of Chronic Pelvic Pain. These conditions greatly affect patients’ quality of life and are often unsatisfactorily treated with conservative measures.
The diagnosis of pudendal nerve entrapment is reached after a comprehensive examination of the patient, including a a detailed history, full physical exam, neurophysiologic studies (EMG and Pudendal nerve motor latency test) and relevant imaging (Pelvic MRI). If the diagnosis is made, then the patient is initially treated with conservative measures (analgesic treatment per-os). Upon failure of medical treatment, pudendal nerve block should be attempted, and if this also proves unsatisfactory, then laparoscopic pudendal nerve decompression is the next therapeutic step.
- The steps of the operation in brief are as follows:
- Placement of 5 trocars
- 1 x13mm optical, 1x10mm, 3x5mm
- Dissection of the peritoneum overlying the ureter and external iliac vein
- Visualization and exposure of Arcus Tendineus Fascia Pelvis (ATFP) and internal iliac vein
- Division of SSL and dissection of the pudendal nerve.
- Placement of omental covering over pudendal nerve.
Creation of peritoneal window medial to obturator nerve
Dissection of Sacrospinous Ligament (SSL) and identification of pudendal atery, nerve and vein coursing through Alcock’s canal.
Transposition of the pudendal nerve to area outside SSL.