The most important clinical application domain of neuropelveology is laparoscopic surgery in the small pelvis. Thanks to this technique, intervention is possible without interfering with the sexual, vesical and intestinal functions of the different organs.
Examples include laparoscopic resections of uterine myomas and partial removal of the uterus with the preservation of the cervix (LASH) in the treatment of benign uterine tumours (Uterus myomatosus). This method helps reduce surgery to a minimum and fully preserves the nerves that are located in the operated region. Surgery may thus reach its therapeutic objective while protecting the patient from the side effects caused by excess treatment. In radical pelvic surgery (such as radical hysterectomy for uterine or cervical cancer or radical prostate or rectum resection), pelvic function can only be preserved if the nerves are identified individually by the LANN technique and if they are subsequently protected during the intervention.
A clear decrease in previously high frequencies of postoperative vesical dysfunction was demonstrated in a study conducted on 273 patients who underwent radical laparoscopic surgery for cervical cancer or rectal endometriosis. Thanks to the techniques employed, only 1% of the patients experienced functional disturbances compared to 20 to 40% in traditional surgery as reported in the literature.
Partial removal of the uterus that preserves the cervix should be preferred
over radical hysterectomy for the following reasons:
- The risk of wounding the bladder or experiencing post-operative bleeding is reduced in the case of the LASH technique.
- Long-term studies have demonstrated that the complete removal of the uterus does not result in a lower incidence of cervical cancer.
- The cervix is the only gynaecological organ which can be protected by targeted anti-cancer prevention.
- All techniques that lead to total hysterectomy increase the risk of future surgicalinterventions to treat incontinence.