Robot-assisted laparoscopic neurolysis for pudendal neuralgia occurring after Richter's sacrospinofixation procedure: A 4-steps technique

Abstract

Introduction

Richter's procedure can be responsible for a pudendal neuralgia when the sacrospinofixation device induces a trauma of the pudendal nerve, that roams under the sacrospinous ligament. In case of a direct compression or irritation of the nerve, the patient can experience a neuropathic pain immediately after surgery, needing a surgical revision. Other patients experience a progressive neuropathic pain several months after surgery, due to a postoperative fibrosis secondary to a hematoma. To demonstrate the feasibility of a neurolysis using a robot-assisted laparoscopy for the pudendal neuralgias occurring after Richter's sacrospinofixation technique.

Material and methods

Between 2021 and 2024, 6 consecutive patients suffering of a pudendal neuralgia after a Richter's procedure were treated with a robot-assisted laparoscopic neurolysis in our center. We report our technique with a narrated video footage.

Results

Robot-assisted laparoscopy for a pudendal neurolysis in 4 steps: Opening of the peritoneum between the external iliac vessels and the umbilical ligament Dissection of the internal iliac and pudendal arteries up to the pudendal nerve Releasing of the pudendal nerve and its branches from the fibrosis Resection of the sacrospinous ligament up to the fixation device The technique was carried out with favorable outcomes.

1. Opening of the peritoneum between the external iliac vessels and the umbilical ligament

2. Dissection of the internal iliac and pudendal arteries up to the pudendal nerve

3. Releasing of the pudendal nerve and its branches from the fibrosis

4. Resection of the sacrospinous ligament up to the fixation device

Conclusion

We demonstrate the feasibility of our technique using a robot-assisted laparoscopy for a complete pudendal neurolysis in case of a neuralgia occurring after Richter's sacrospinofixation.