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First case-series of robot-assisted pudendal nerve release: technique and outcomes

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Abstract

Objective

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).

Patients and methods

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.

Results

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).

Conclusions

RPNR is a safe and effective approach for the pain resolution caused by PNE. Timely nerve decompression is suggested to enhance outcomes.

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Author notes

  1. Carlo Giulioni and Anastasios D. Asimakopoulos have contributed equally to this work and are considered as first authors.

Authors and Affiliations

  1. Department of Urology, University Hospital “Ospedali Riuniti”, Ancona, Italy

    Carlo Giulioni & Andrea Benedetto Galosi

  2. Unit of Urology, Fondazione PTV Policlinico Tor Vergata, Rome, Italy

    Anastasios D. Asimakopoulos

  3. Unit of Urology, Azienda Toscana Sud-Est, San Donato Hospital, Arezzo, Italy

    Filippo Annino

  4. Department of Urology, ASST FBF Sacco, Milan, Italy

    Giulia Garelli

  5. Urology Department, Clinique Saint Augustin, Bordeaux, France

    Julien Riviere, Julie Piechaud-Kressmann, Nam-Son Vuong, Laurent Hugo Lopez, Jean-Baptiste Roche, Jean Rouffilange, Jean-Luc Hoepffner, Richard Pierre Gaston, Thierry Piechaud & Grégory Pierquet

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  1. Carlo Giulioni
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  2. Anastasios D. Asimakopoulos
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  4. Giulia Garelli
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  12. Andrea Benedetto Galosi
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  13. Richard Pierre Gaston
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  14. Thierry Piechaud
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  15. Grégory Pierquet
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Contributions

All authors have made a significant contribution to the findings and methods in the paper. All authors have read and approved the final draft and consider the manuscript to be honest work.

Corresponding author

Correspondence to Anastasios D. Asimakopoulos.

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Disclosures

Carlo Giulioni, Anastasios D. Asimakopoulos, Filippo Annino, Giulia Garelli, Julien Riviere, Julie Piechaud-Kressmann, Nam-Son Vuong, Laurent Hugo Lopez, Jean-Baptiste Roche, Jean Rouffilange, Jean-Luc Hoepffner, Andrea Benedetto Galosi, Richard Pierre Gaston, Thierry Piechaud, Grégory Pierquet have no conflicts of interest or financial ties to disclose.

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Giulioni, C., Asimakopoulos, A.D., Annino, F. et al. First case-series of robot-assisted pudendal nerve release: technique and outcomes. Surg Endosc 37, 5708–5713 (2023). https://doi.org/10.1007/s00464-023-10096-9

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