Excision of a Deeply Infiltrating Endometriosis Nodule and Neuroma Involving the Sacral Nerve Root Plexus Adjacent to the Ischial Spine

Abstract

Study Objective Present a surgical video that demonstrates the use of anatomic landmarks and dissection techniques for the laparoscopic excision of deeply infiltrative endometriosis at the ischial spine. This video will highlight the anatomy relevant to performing a nerve sparing technique to minimize neurological sequelae when excising nodules adjacent to the sacral nerve plexus and inferior hypogastric nerve. Design Surgical Educational Video. Setting Tertiary Referral Center at an Academic Residency Program. Patients or Participants 30-yo G0P0 with cyclical dysmenorrhea, gluteal pain, & dyspareunia that presented with a 2cm deeply infiltrative endometriotic nodule at the level of the ischial spine. Interventions Laparoscopic excision of deeply infiltrative endometriotic nodule at the ischial spine utilizing a nerve sparing technique. Measurements and Main Results 3.5 × 1.7 × 1.8 cm endometriotic nodule was confirmed by pathology. Immunohistochemical findings of +CD-10 which is consistent with stroma surrounding endometriosis and +S-100 consistent with neuroma. Operative time 145 minutes. EBL 25mL. Conclusion Surgical excision of Deeply Infiltrative Endometriotic lesions at the level of the ischial spine present unique challenges. By employing knowledge of the anatomy of the sacral nerve root plexus in relation to the ischial spine, inferior hypogastric plexus, inferior hypogastric plexus, and avascular planes, safe nerve sparing excision can be accomplished. Present a surgical video that demonstrates the use of anatomic landmarks and dissection techniques for the laparoscopic excision of deeply infiltrative endometriosis at the ischial spine. This video will highlight the anatomy relevant to performing a nerve sparing technique to minimize neurological sequelae when excising nodules adjacent to the sacral nerve plexus and inferior hypogastric nerve. Surgical Educational Video. Tertiary Referral Center at an Academic Residency Program. 30-yo G0P0 with cyclical dysmenorrhea, gluteal pain, & dyspareunia that presented with a 2cm deeply infiltrative endometriotic nodule at the level of the ischial spine. Laparoscopic excision of deeply infiltrative endometriotic nodule at the ischial spine utilizing a nerve sparing technique. 3.5 × 1.7 × 1.8 cm endometriotic nodule was confirmed by pathology. Immunohistochemical findings of +CD-10 which is consistent with stroma surrounding endometriosis and +S-100 consistent with neuroma. Operative time 145 minutes. EBL 25mL. Surgical excision of Deeply Infiltrative Endometriotic lesions at the level of the ischial spine present unique challenges. By employing knowledge of the anatomy of the sacral nerve root plexus in relation to the ischial spine, inferior hypogastric plexus, inferior hypogastric plexus, and avascular planes, safe nerve sparing excision can be accomplished.