The Birth of Neuropelveology
Disorders affecting pelvic nerves have been known for a long time. Treating nerve lesions with neurosurgery is thus a traditional medical procedure. However, neuropelveology is an entirely new domain.
Unlike the nerves found in the limbs that can be easily accessed by surgery thanks to their superficial location, pelvic nerves are buried deep inside the small pelvis, sometimes behind the rectum and at other times underneath blood vessels or other organs. As a result and unless extensive efforts are deployed, they remain inaccessible by classical surgical means (abdominal, transgluteal or transperineal surgery). It was only with the advent of laparoscopy that microsurgical treatment of pelvic nerves became practical.
Laparoscopy offers the following advantages:
- An endoscope fitted with a camera offers an optimal view of all structures of the small pelvis with good lighting and magnification, much like a microscope.
- The long, fine laparoscopy instruments are ideal for performing microsurgery on different nerves or for implanting mini-electrodes.
- Thanks to the introduction of the intra-operative electrostimulation of pelvic nerves (a technique called LANN, or LAparoscopic Neuro-Navigation), it has become possible to assess the functional status of the nerves.