First case-series of robot-assisted decompression for pudendal nerve entrapment: technique and outcomes
Abstract
Objective: Pudendal Nerve Entrapment (PNE) may determine chronic pelvic pain associated with symptoms related to its innervation area. This study aimed present the technique and to 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-July 2021 were recruited. Following the identification of the medial umbilical ligament, the space between this ligament and the ipsilateral external iliac pedicle is progressively dissected in order to identify the obturator nerve. The dissection medial to this nerve identifies the obturator vein and the arcus tendineous of the levator ani, that is cranially inserted to 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
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 reduction of the pain 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 resolution of pain caused by PNE. Timely nerve decompression is suggested to enhance outcomes.