Ceccaroni Marcello, Clarizia Roberto, Alboni Carlo, Ruffo Giacomo, Bruni Francesco, Roviglione Giovanni, Scioscia Marco, Peters Inge, De Placido Giuseppe, Minelli Luca
Gynecologic Oncology Division, Department of Obstetrics and Gynecology, European Gynaecology Endoscopy School, Sacred Heart Hospital "Ospedale Sacro Cuore-Don Calabria", Via Don A. Sempreboni no. 5, 37024, Negrar, Verona, Italy.
Surg Radiol Anat. 2010 Jul;32(6):601-4. doi: 10.1007/s00276-010-0624-6. Epub 2010 Jan 20.
Endometriotic or fibrotic involvement of sacral plexus and pudendal and sciatic nerves may be quite frequently the endopelvic cause of ano-genital and pelvic pain. Feasibility of a laparoscopic transperitoneal approach to the somatic nerves of the pelvis was determined and showed by Possover et al. for diagnosis and treatment of ano-genital pain caused by pudendal and/or sacral nerve roots lesions and adopted at our institution. In this paper we report our experience and anatomo-surgical consideration regarding this technique.
Confidence with this technique was obtained after several laparoscopic and laparotomic dissections on fresh, embalmed and formalin-fixed female cadavers and is now routinely performed at our institution in all cases of extensive endometriosis of the pelvic wall, involving the somatic nerves.
We describe two different laparoscopic transperitoneal approaches to the lateral pelvic wall in case of: (A) deep pelvic endometriosis with rectal and/or parametrial involvement extending to pelvic wall and somatic nerves; (B) isolated endometriosis of pelvic wall and somatic nerves.
Laparoscopic transperitoneal retroperitoneal nerve-sparing approach to the pelvic wall proved to be a feasible and useful procedure even if limited to referred laparoscopic centers and anatomically experienced and skilled surgeons.
骶丛、阴部神经和坐骨神经的子宫内膜异位或纤维化累及可能是导致肛门生殖器和盆腔疼痛的常见盆腔内原因。Possover等人确定并展示了一种腹腔镜经腹入路处理盆腔躯体神经的可行性，该方法用于诊断和治疗由阴部神经和/或骶神经根病变引起的肛门生殖器疼痛，并在我们机构采用。在本文中，我们报告了我们关于该技术的经验以及解剖学和手术方面的考虑。
在对新鲜、防腐处理和福尔马林固定的女性尸体进行多次腹腔镜和剖腹解剖后，我们对该技术有了信心，现在我们机构对所有累及躯体神经的盆腔壁广泛子宫内膜异位病例都常规进行该操作。
我们描述了两种不同的腹腔镜经腹入路处理盆腔侧壁的情况：（A）深部盆腔子宫内膜异位，累及直肠和/或子宫旁组织并延伸至盆腔壁和躯体神经；（B）盆腔壁和躯体神经孤立性子宫内膜异位。
腹腔镜经腹腹膜后保留神经的盆腔壁入路被证明是一种可行且有用的手术，即使仅限于有经验的腹腔镜中心以及在解剖学方面经验丰富且技术熟练的外科医生。
