Targeted Excision of Deep Nerve Endometriosis (Sciatic–Pudendal–Presacral) with Ionm-Guided Surgical Precision

Study Objective

To illustrate how intraoperative neurophysiological monitoring (IONM)-guided laparoscopy improves the precision of endometriosis excision and facilitates optimal nerve preservation.

Design

Video Article- Case Presentation

Setting

Tertiary referral center specializing in advanced endometriosis surgery

Patients or Participants

A 36-year-old female with a history of multiple prior laparoscopic procedures presented with chronic, debilitating right-sided pelvic pain, including sciatic pain, pudendal neuralgia, dyspareunia, and functional limitation due to nerve-related symptoms.

Interventions

IONM-guided laparoscopic excision of deep endometriosis nodule

Measurements and Primary Results

IONM enabled real-time identification and functional verification of critical neural structures, including the sciatic and pudendal nerves. A fibrotic endometriotic nodule involving adjacent vascular structures was successfully excised while preserving surrounding nerves. Postoperatively, the patient experienced marked symptom improvement without the development of new neurological deficits.

Conclusion

This case highlights the utility of IONM-assisted laparoscopy in complex endometriosis surgery involving neural structures. IONM enables accurate identification and preservation of pelvic nerves, enhancing both surgical safety and patient outcomes in advanced cases of deep infiltrating endometriosis with nerve proximity or involvement.