Anatomy of the Sacral Roots and the Pelvic Splanchnic Nerves in Women Using the LANN Technique

Abstract

To report on our anatomic and electrophysiologic findings about the sacral nerve roots and the pelvic splanchnic nerves during laparoscopic pelvic surgery. The pelvic splanchnic nerves and the sacral nerve roots were dissected in 336 consecutive patients undergoing laparoscopy for pelvic pain syndrome or gynecologic diseases. Intraoperative assessment of the functionality of the exposed nerves was performed using the LAparoscopic Neuro-Navigation (LANN) technique. Dissection of the sacral roots and the splanchnic pelvic nerves lateral to the sacral hypogastric fascia was feasible without any complications in all patients in this series. The mean surgical time was 16 minutes per side. The pelvic splanchnic nerves could be divided anatomically and functionally into vesical and rectal nerve fibers. Laparoscopy in combination with the LANN technique not only permits an intraoperative functional mapping of the pelvic motoric autonomous nerves but also a differentiation between the vesical and rectal nerves and between the efferent and afferent pelvic nerves.