Laparoscopic exposure and electrostimulation of the somatic and autonomous pelvic nerves: a new method for implantation of neuroprothesis in paralyzed patients?

Abstract

The purpose of this study was to demonstrate the feasibility of the laparoscopic approach to expose the pelvic autonomous and somatic nerves for possible implantation of neuroprothesis for restoration of locomotion, micturition, defecation and ejaculation in paralyzed patients. In 146 patients undergoing laparoscopic para-aortic and pelvic lymphadenectomy for cervical cancer, sympathetic, parasympathetic and somatic nerves were precisely exposed in the para-aortic region and in the pelvis, which then allowed electrostimulation of the different nerves. In order to evaluate the motor activity of the stimulated nerves, transurethral and transrectal pressure catheters were employed. Systematic laparoscopic exposure of all somatic and autonomous pelvic nerves was carried out in all 146 consecutive patients without any complications. Intraoperative neurostimulation demonstrated the exact function of the different exposed autonomic nerves. Selective laparoscopic implantation of neuroelectrodes to the somatic and autonomic pelvic nerves in a paralyzed patient may be a feasible and reproducible procedure for surgeons well-trained in laparoscopic surgery.