Laparoscopic Approach to Multi-Nerve Involvement of Endometriosis

Study Objective

Our objective is to review the surgical approach to excision of a deep endometriosis lesion involving multiple pelvic nerves.

Design

Using annotated intraoperative footage, we will review the lateral and medial approaches to dissection of the sciatic and superior gluteal nerves, lumbosacral trunk and sacral nerve roots.

Setting

Academic medical center. Patient in dorsal lithotomy position with camera in umbilical port, with accessory ports in the bilateral lower quadrants and at Jain point.

Patients or Participants

35yo G0 with 3-year history of progressive foot drop and sciatica, with MRI demonstrating deep infiltrating endometriosis involving the sciatic and superior gluteal nerves and lumbosacral trunk.

Interventions

Medial and lateral approach to dissection, with complete excision of endometriosis at the conclusion of procedure.

Measurements and Primary Results

Patient followed clinically and is four months post-op at the time of submission.

Conclusion

A thorough understanding of the relevant anatomy is required for safe excision of endometriosis involving the pelvic nerves.