Pudendal Neurolysis: 6-Step Laparoscopic Approach.

ABSTRACT

OBJECTIVE: To demonstrate the safety and feasibility of the laparoscopic approach to perform pudendal neurolysis in a case of pudendal nerve entrapment syndrome [1-3]. DESIGN: A video tutorial that highlights the laparoscopic steps to performing pudendal neurolysis, with a focus on the main anatomic landmarks [4,5]. SETTING: A tertiary care regional hospital. INTERVENTIONS: This video shows a 6-step approach to laparoscopic pudendal neurolysis for the treatment of pudendal nerve entrapment between the sacrospinous and sacrotuberous ligaments [2,6-8]. Step 1 Identification of the umbilical artery. Step 2 Dissection and development of the lateral paravesical space until the pelvic floor. Step 3 Identification of the arcus tendineus of the endopelvic fascia. Step 4 Identification of the ischial spine and the sacrospinous ligament covered by the coccygeus muscle. Step 5 Coagulation and section of the coccygeus muscle and the sacrospinous ligament. Step 6 Medialization of the pudendal nerve until its entrance into the Alcock canal. CONCLUSION: This video demonstrates the safety, feasibility, and reproducibility of laparoscopic pudendal neurolysis in 6 steps. A minimally invasive approach is adequate to treat the pudendal compression until the Alcock canal [2].