Real-time nerve mapping for endometriosis involving the sciatic and pudendal nerves

Area of Science:

• Minimally Invasive Surgery
• Neurophysiology
• Gynecological Surgery

Background:

• Deep infiltrating endometriosis poses significant surgical challenges.
• Nerve damage during surgery can lead to chronic pain and functional deficits.
• Standard surgical techniques may not adequately protect deep pelvic nerves.

Purpose of the Study:

• To present a standardized technique for deep infiltrating endometriosis surgery.
• To demonstrate the utility of intraoperative neurophysiological monitoring (IONM) for nerve preservation.
• To improve surgical safety and facilitate deep pelvic nerve protection.

Main Methods:

• A video article detailing laparoscopic excision of endometriosis.
• Utilized IONM with real-time nerve mapping to monitor sciatic, obturator, and pudendal nerves.
• Employed motor-evoked potentials and H-reflex for functional integrity assessment.

Main Results:

• Successful laparoscopic excision without intraoperative complications.
• IONM confirmed continuous functional integrity of major pelvic nerves throughout the procedure.
• Postoperative improvement in neuropathic pain and mobility, with no new deficits.

Conclusions:

• Multimodal IONM facilitates safe and effective nerve-sparing excision of deep infiltrating endometriosis.
• This approach enhances precision in complex gynecological surgeries.
• IONM is valuable for preserving sciatic and pudendal nerve function during endometriosis surgery.