Minimally Invasive Treatment of a Rare Condition Causing Chronic Pelvic Pain: Vascular Entrapment of the Lumbosacral Plexus

Abstract

Study Objective To report outcomes of the vascular entrapment of the sacral plexus treated by minimally invasive surgery. Design Retrospective cohort study. Setting Tertiary unit specializing in advanced gynecologic surgery and neuropelveology. Patients or Participants A total of 23 patients suffering from chronic pelvic pain with the involvement of the lumbosacral plexus were included in this study. 9 out of 23 patients underwent robot-assisted laparoscopic surgery and conventional laparoscopic surgery with 3D technology were performed in 14 patients for treatment of the vascular entrapment of the lumbosacral plexus. Interventions Laparoscopic or robot-assisted laparoscopic excision of the abnormal vessels located on the lumbosacral plexus and decompression of the nerve roots. Measurements and Main Results The mean age of the patients was 35.13. All patients were suffering from chronic pelvic pain and the most common coexisting symptoms were dysmenorrhea, sciatica, vulvodynia and pudendal neuralgia. Motor deficit was seen only in two patients. Vascular entrapment was visualized on the left side in 16 patients and on the right side in 7 patients. Vascular entrapment of the lumbosacral plexus in different locations were first dissected then clipped (in 12 patients), coagulated and cut in all patients. Thrombosis of the external iliac artery occurred in one patient, postoperatively. In two patients pain persisted following operation and recurrence was observed in one patient. Conclusion Since lumbosacral plexus is located over the sacral bone, it can be entrapped easily by abnormal vessels crossing over the plexus. Radiating pain to lower limbs or genital area and also motor deficit of the lower limbs in patients with chronic pelvic pain were investigated in detail for the presence of vascular entrapment of the lumbosacral plexus. The minimally invasive surgery with three-dimensional vision provides improvement of the sensation of depth in the deepest parts of the pelvis and minimizes complications.