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. 2023 Jul;37(7):5708-5713.
doi: 10.1007/s00464-023-10096-9. Epub 2023 May 19.

First case-series of robot-assisted pudendal nerve release: technique and outcomes

Carlo Giulioni #  1 , Anastasios D Asimakopoulos #  2 , Filippo Annino  3 , Giulia Garelli  4 , Julien Riviere  5 , Julie Piechaud-Kressmann  5 , Nam-Son Vuong  5 , Laurent Hugo Lopez  5 , Jean-Baptiste Roche  5 , Jean Rouffilange  5 , Jean-Luc Hoepffner  5 , Andrea Benedetto Galosi  1 , Richard Pierre Gaston  5 , Thierry Piechaud  5 , Grégory Pierquet  5
Affiliations

First case-series of robot-assisted pudendal nerve release: technique and outcomes

Carlo Giulioni et al. Surg Endosc. 2023 Jul.

Abstract

Objective: Pudendal Nerve Entrapment (PNE) may determine chronic pelvic pain associated with symptoms related to its innervation area. This study aimed to present the technique and report the outcomes of the first series of robot-assisted pudendal nerve release (RPNR).

Patients and methods: 32 patients, who were treated with RPNR in our centre between January 2016 and July 2021, were recruited. Following the medial umbilical ligament identification, the space between this ligament and the ipsilateral external iliac pedicle is progressively dissected to identify the obturator nerve. The dissection medial to this nerve identifies the obturator vein and the arcus tendinous of the levator ani, which is cranially inserted into the ischial spine. Following the cold incision of the coccygeous muscle at the level of the spine, the sacrospinous ligament is identified and incised. The pudendal trunk (vessels and nerve) is visualized, freed from the ischial spine and medially transposed.

Results: The Median duration of symptoms was 7 (5, 5-9) years. The median operative time was 74 (65-83) minutes. The median length of stay was 1 (1-2) days. There was only a minor complication. At 3 and 6 months after surgery, a statistically significant pain reduction has been encountered. Furthermore, the Pearson correlation coefficient reported a negative relationship between the duration of pain and the improvement in NPRS score, - 0.81 (p = 0.01).

Conclusions: RPNR is a safe and effective approach for the pain resolution caused by PNE. Timely nerve decompression is suggested to enhance outcomes.

Keywords: Pelvic floor disorders; Pelvic pain; Pudendal nerve; Pudendal nerve entrapment; Pudendal neuralgia; Robot-assisted surgery.

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