Laparoscopic Pudendal Nerve Release at the Level of Sacrospinous Ligament

Pudendal nerve release can be managed by the laparoscopic approach for pudendal nerve entrapment.

This is a case report of a stepwise demonstration of the technique with narrated video footage. A 71-year-old woman, gravid 7, parity 3, abortion 4, live births 3 vaginal delivery, complained of pain while sitting. She had been having vaginal and vulvar pain on the left side for 3 years. At vaginal examination, she had pain over the sacrospinous ligament with palpation. Tinel's sign (+) on the left side. Left side pudendal nerve block relieves pain for 1 h. Using a laparoscopic approach for a left pudendal nerve release at the level of sacrospinous ligament, the dissection started at the level of medial to the infundibulopelvic ligament, after visualization of obliterated umbilical artery and obturator nerve and vessels, dissection continued deeper to the pelvic floor visualizing the obturator internus muscle, then pudendal nerve and vessels are identified and the coccygeus muscle and sacrospinous ligament are observed. The sacrospinous ligament is cut all the way to the entrance of Alcock's canal.

The operation was finished without any complication and the patient was discharged after the operation day. Pain decreased on her postoperative examination. Follow-up visits will be continued at 3 and 6 months.

Laparoscopic pudendal nerve release is reproducible, effective, safe, and has a steep learning curve method for the management of pudendal nerve entrapment.