' '
Deutsch | English    

Forschungsdatenbank PMU-SQQUID

New laparoscopic approach to the pudendal nerve for neuromodulation based on an anatomic study.
Konschake, M; Brenner, E; Moriggl, B; Hormann, R; Bauer, S; Foditsch, E; Janetschek, G; Kunzel, KH; Sievert, KD; Zimmermann, R
Neurourol Urodyn. 2017; 36(4):1069-1075
Originalarbeiten (Zeitschrift)

PMU-Autor/inn/en

Bauer Sophina
Janetschek Günter
Keller Elena Esra
Sievert Karl-Dietrich

Abstract

AIMS
The aim was to develop a new laparoscopic technique for placement of a pudendal lead.
Development of a direct, feasible and reliable minimal-invasive laparoscopic approach to the pudendal nerve (PN). Thirty-one embalmed human specimens were dissected for the relevant anatomic structures of the pelvis. Step-by-step documentation and analysis of the laparoscopic approach in order to locate the PN directly in its course around the medial part of the sacrospinous ligament and test this approach for feasibility. Landmarks for intraoperative navigation towards the PN as well as the possible position of an lead were selected and demonstrated.
The visible medial umbilical fold, the intrapelvine part of the internal pudendal artery, the coccygeus muscle and the sacrospinous ligament are the main landmarks. The PN traverses the medial part of the sacrospinous ligament dorsally, medially to the internal pudendal artery. The medial part of the sacrospinous ligament has to be exposed in order to display the nerve. An lead can be placed ventrally on the nerve or around it, depending on the lead type or shape.
A precise and reliable identification of the PN by means of laparoscopy is feasible with an easy four-step approach: (1) identification of the medial umbilical fold; (2) identification of the internal iliac artery; (3) identification of the internal pudendal artery and incision of the coccygeus muscle ("white line", arcuated line); and (4) exposition of the medial part of the sacrospinous ligament to display the PN.


Useful keywords (using NLM MeSH Indexing)

Cadaver

Electric Stimulation Therapy*

Electrodes, Implanted*

Feasibility Studies

Humans

Laparoscopy*

Pelvis/anatomy*

histology

Pelvis/surgery

Prosthesis Implantation/methods*

Pudendal Nerve/anatomy*

histology

Pudendal Nerve/surgery*


Find related publications in this database (Keywords)

internal pudendal artery
laparoscopic approach
medial umbilical fold
neuromodulation
pudendal nerve
sacrospinous ligament