Right laparoscopic pudendal release + neurostimulator prosthesis (LION procedure) in pudendal neuralgia

Abstract

Aim Pudendal neuralgia is a highly disabling entity with complex diagnostic and controversial treatment results. Surgical neurolysis has been shown to be the most effective treatment. Sacral root neurostimulation or posterior tibial nerve stimulation are used to rescue patients who either have not responded to surgery or have worsened after an initial improvement. Methods Given the excellent visualization of the pudendal nerve during laparoscopic pudendal release, we propose to combine this procedure with neurostimulation, taking advantage of the possibility of in situ placement of the electrode. The abdominal cavity is accessed laparoscopically through four ports, and after identifying and releasing the pudendal nerve a neurostimulation electrode is placed next to the nerve and is connected to a generator located in a subcutaneous pocket. Results This procedure has been performed in one patient with a satisfactory result. Conclusions Laparoscopic pudendal release with neurostimulator prosthesis is an experimental technique that can be promising for the treatment of pudendal neuralgia.

Pudendal Nerve Neurolysis in Patients Afflicted With Pudendal Nerve Entrapment: A Systematic Review of Surgical Techniques and Their Efficacy

“…For patients without nerve lesions or those with systemic neurological conditions (e.g., multiple sclerosis), a neuromodulator was concurrently implanted as part of the LION (laparoscopic implantation of neuroprosthesis) procedure, with the aim to modulate afferent neuronal transmission from S2-5 sacral routes. A similar technique was also documented in the case report by Moncada et al [27].…”

“…Among the included studies, 11 were retrospective [12-17, 22, 26, 29, 36, 38], 11 were prospective [10,18,19,21,23,28,[31][32][33][34][35], 7 were case reports [11,20,25,27,30,37,39], and one was a randomized trial [24]. The surgical techniques utilized exhibited variation, encompassing transperineal open surgery in 8 studies [10][11][12][13][14][15][16][17], transgluteal in 8 studies [18][19][20][21][22][23][24][25], and the remainder adopting minimally invasive approaches, which comprised 12 laparoscopic [26][27][28][29][30][31][32][33][34][35][36][3...…”