Department of Urology, University Hospital "Ospedali Riuniti", Ancona, Italy.
Unit of Urology, Fondazione PTV Policlinico Tor Vergata, Rome, Italy.
Surg Endosc. 2023 Jul;37(7):5708-5713. doi: 10.1007/s00464-023-10096-9. Epub 2023 May 19.
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).
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.
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).
RPNR is a safe and effective approach for the pain resolution caused by PNE. Timely nerve decompression is suggested to enhance outcomes.
阴部神经受压（PNE）可能导致与阴部神经支配区域相关症状的慢性盆腔疼痛。本研究旨在介绍机器人辅助阴部神经松解术（RPNR）的技术，并报告我们中心第一系列的结果。
我们中心于 2016 年 1 月至 2021 年 7 月期间治疗了 32 名接受 RPNR 治疗的患者。在识别出脐正中韧带后，逐步在该韧带和同侧髂外支之间的空间进行解剖，以识别闭孔神经。在该神经的内侧解剖可识别出闭孔静脉和肛提肌的腱弓，该腱弓在颅侧插入坐骨棘。在水平于脊柱的尾骨肌冷切后，识别并切开骶棘韧带。阴部干（血管和神经）可见，从坐骨棘上松解并向内侧移位。
症状的中位数持续时间为 7 年（5 年，5-9 年）。中位数手术时间为 74 分钟（65-83 分钟）。中位数住院时间为 1 天（1-2 天）。仅有轻微并发症。术后 3 个月和 6 个月，疼痛明显减轻。此外，Pearson 相关系数报告疼痛持续时间与 NPRS 评分改善呈负相关，-0.81（p=0.01）。
RPNR 是治疗 PNE 引起的疼痛的安全有效方法。建议及时进行神经减压以提高疗效。
