The laparoscopic neurolysis of the pudendal nerve for the therapy of the Alcock ́s Canal Syndrome after sacrospinous fixation for vaginal prolaps

Introduction Since improvment of the telemedicine allows magnification effect and optimal conditions of dissection even in the deepness of the pelvic retroperitoneum, laparoscopic surgery is becoming one of the most usefull and important instrument for learning the pelvic retroperitoneal anatomy. Laparoscopic exposure of all pelvic nerves 10 becam feasable routinely 1 and use of Laparoscopic Neuronavigation LANN technique permit intraoperative assessment of the motoric functionality of the exposed somatic and autonomous nerves 2 . Thus not only new basic knowledge concerning the neuro-functional pelvic anatomy in women were won but also a specific neurofunctional cartography can be elaborated in short surgical time in each patient: „Parasympathetic nervesparing technique“ in radical pelvic surgery is based on this kind of exposure and sparing of the pelvic splanchnic nerves during 15 transection of the parametries for reduction of postoperative functional morbidity of the bladder and of the rectum 3,4 . If laparoscopy allows sparing of the pelvic nerves, it allows also direct surgery on ist too: In our first serie of „laparoscopic pelvic neurosurgery“ we shows our firts results for the laparoscopic neurolysis of the sciatic nerve in patients with an extended infiltration of the obturatoric fossa by severe endometriosis 5 . In the present work, we shows an other indication for laparoscopic neurosurgery, the laparosopic neurolysis of the pudendal nerve in patient 20 with „Alcock canal syndrom“ secondary to vaginal sacrospinous fixation after Amreich-Richter for genital prolaps.