Integration of Intraoperative Neurophysiological Monitoring into Laparoscopic Pelvic Nerve Decompression Surgery: A Novel Technique for Protecting Pelvic Nerves
Background: This study aims to present a novel technique that integrates intraoperative neurophysiological monitoring (IONM) into laparoscopy for continuous monitoring of pelvic nerves at risk during surgery to ensure their protection. Methods: This is a prospective analysis of 10 consecutive patien...
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| Format: | Article |
| Language: | English |
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IMR Press
2023-09-01
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| Series: | Clinical and Experimental Obstetrics & Gynecology |
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| Online Access: | https://www.imrpress.com/journal/CEOG/50/9/10.31083/j.ceog5009198 |
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| author | Elif Cansu Gundogdu Ahmet Kale Metin Mercan Vildan Yayla Ugur Efe Ozcan Taner Usta Esra Keles |
| author_facet | Elif Cansu Gundogdu Ahmet Kale Metin Mercan Vildan Yayla Ugur Efe Ozcan Taner Usta Esra Keles |
| author_sort | Elif Cansu Gundogdu |
| collection | DOAJ |
| description | Background: This study aims to present a novel technique that integrates intraoperative neurophysiological monitoring (IONM) into laparoscopy for continuous monitoring of pelvic nerves at risk during surgery to ensure their protection. Methods: This is a prospective analysis of 10 consecutive patients receiving surgical treatment for proven diagnosis of lumbosacral plexus nerve entrapment. Patients with symptoms of chronic pelvic pain, dyspareunia, dysmenorrhea, and severe, burning sharp pain on the lower extremity dermatomes were included. Laparoscopic decompression of lumbosacral plexus nerve entrapment with intraoperative neuromonitoring was performed between January 2021 and February 2022. Intraoperative neuromonitoring records (spontaneous electromyography (EMG), free-run EMG recordings, transcranial electrical motor-evoked potentials (TcMEP) recordings, direct nerve root stimulation recordings, and compound muscle action potentials (CMAPs) recordings) and preoperative and postoperative pain symptoms at one month were analyzed. Results: The median age of the patients was 29 (25–44) years. Neurovascular conflict, fibrosis, and abnormal piriformis muscle were identified as the three main etiologies of nerve entrapments. There were no statistically significant differences in transcranial motor evoked potential responses on the operated extremity side before and after decompression surgery or in the amplitude difference changes of TcMEP responses between the operated and non-operated extremity sides (p > 0.05). Dyspareunia visual analogue scale (VAS) scores showed a significant decrease at the first month postoperatively (p-value = 0.027). Conclusions: Integrating intraoperative neurophysiological monitoring into laparoscopy facilitates the monitoring of the patient’s motor function and prevents both permanent and transient nerve damage during pelvic nerve decompression surgery. This technique holds promise in enhancing surgical safety and preserving pelvic nerve function. The study was registered at https://clinicaltrials.gov (registration number NCT06009640). |
| format | Article |
| id | doaj-art-61703d64ab41499e99a6c7afbdd81d10 |
| institution | OA Journals |
| issn | 0390-6663 |
| language | English |
| publishDate | 2023-09-01 |
| publisher | IMR Press |
| record_format | Article |
| series | Clinical and Experimental Obstetrics & Gynecology |
| spelling | doaj-art-61703d64ab41499e99a6c7afbdd81d102025-08-20T02:23:45ZengIMR PressClinical and Experimental Obstetrics & Gynecology0390-66632023-09-0150919810.31083/j.ceog5009198S0390-6663(23)02202-9Integration of Intraoperative Neurophysiological Monitoring into Laparoscopic Pelvic Nerve Decompression Surgery: A Novel Technique for Protecting Pelvic NervesElif Cansu Gundogdu0Ahmet Kale1Metin Mercan2Vildan Yayla3Ugur Efe Ozcan4Taner Usta5Esra Keles6Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Kartal Dr. Lutfi Kirdar City Hospital, 34865 Istanbul, TurkeyDepartment of Obstetrics and Gynecology, University of Health Sciences Turkey, Gaziosmanpasa Research and Training Hospital, 34255 Istanbul, TurkeyDepartment of Neurology, University of Health Sciences Turkey, Bakirkoy Sadi Konuk Research and Training Hospital, 34147 Istanbul, TurkeyDepartment of Neurology, University of Health Sciences Turkey, Bakirkoy Sadi Konuk Research and Training Hospital, 34147 Istanbul, TurkeyDepartment of Neurosurgery, University of Health Sciences Turkey, Kartal Dr. Lutfi Kirdar City Hospital, 34865 Istanbul, TurkeyDepartment of Obstetrics and Gynecology, Acibadem Altunizade Hospital, Acibadem Mehmet Ali Aydinlar University, 34662 Istanbul, TurkeyDepartment of Obstetrics and Gynecology, University of Health Sciences Turkey, Kartal Dr. Lutfi Kirdar City Hospital, 34865 Istanbul, TurkeyBackground: This study aims to present a novel technique that integrates intraoperative neurophysiological monitoring (IONM) into laparoscopy for continuous monitoring of pelvic nerves at risk during surgery to ensure their protection. Methods: This is a prospective analysis of 10 consecutive patients receiving surgical treatment for proven diagnosis of lumbosacral plexus nerve entrapment. Patients with symptoms of chronic pelvic pain, dyspareunia, dysmenorrhea, and severe, burning sharp pain on the lower extremity dermatomes were included. Laparoscopic decompression of lumbosacral plexus nerve entrapment with intraoperative neuromonitoring was performed between January 2021 and February 2022. Intraoperative neuromonitoring records (spontaneous electromyography (EMG), free-run EMG recordings, transcranial electrical motor-evoked potentials (TcMEP) recordings, direct nerve root stimulation recordings, and compound muscle action potentials (CMAPs) recordings) and preoperative and postoperative pain symptoms at one month were analyzed. Results: The median age of the patients was 29 (25–44) years. Neurovascular conflict, fibrosis, and abnormal piriformis muscle were identified as the three main etiologies of nerve entrapments. There were no statistically significant differences in transcranial motor evoked potential responses on the operated extremity side before and after decompression surgery or in the amplitude difference changes of TcMEP responses between the operated and non-operated extremity sides (p > 0.05). Dyspareunia visual analogue scale (VAS) scores showed a significant decrease at the first month postoperatively (p-value = 0.027). Conclusions: Integrating intraoperative neurophysiological monitoring into laparoscopy facilitates the monitoring of the patient’s motor function and prevents both permanent and transient nerve damage during pelvic nerve decompression surgery. This technique holds promise in enhancing surgical safety and preserving pelvic nerve function. The study was registered at https://clinicaltrials.gov (registration number NCT06009640).https://www.imrpress.com/journal/CEOG/50/9/10.31083/j.ceog5009198intraoperative neurophysiological monitoring (ionm)laparoscopic surgerypelvic nerve decompressionlumbosacral plexusneuromonitoringperipheral nerve entrapment |
| spellingShingle | Elif Cansu Gundogdu Ahmet Kale Metin Mercan Vildan Yayla Ugur Efe Ozcan Taner Usta Esra Keles Integration of Intraoperative Neurophysiological Monitoring into Laparoscopic Pelvic Nerve Decompression Surgery: A Novel Technique for Protecting Pelvic Nerves Clinical and Experimental Obstetrics & Gynecology intraoperative neurophysiological monitoring (ionm) laparoscopic surgery pelvic nerve decompression lumbosacral plexus neuromonitoring peripheral nerve entrapment |
| title | Integration of Intraoperative Neurophysiological Monitoring into Laparoscopic Pelvic Nerve Decompression Surgery: A Novel Technique for Protecting Pelvic Nerves |
| title_full | Integration of Intraoperative Neurophysiological Monitoring into Laparoscopic Pelvic Nerve Decompression Surgery: A Novel Technique for Protecting Pelvic Nerves |
| title_fullStr | Integration of Intraoperative Neurophysiological Monitoring into Laparoscopic Pelvic Nerve Decompression Surgery: A Novel Technique for Protecting Pelvic Nerves |
| title_full_unstemmed | Integration of Intraoperative Neurophysiological Monitoring into Laparoscopic Pelvic Nerve Decompression Surgery: A Novel Technique for Protecting Pelvic Nerves |
| title_short | Integration of Intraoperative Neurophysiological Monitoring into Laparoscopic Pelvic Nerve Decompression Surgery: A Novel Technique for Protecting Pelvic Nerves |
| title_sort | integration of intraoperative neurophysiological monitoring into laparoscopic pelvic nerve decompression surgery a novel technique for protecting pelvic nerves |
| topic | intraoperative neurophysiological monitoring (ionm) laparoscopic surgery pelvic nerve decompression lumbosacral plexus neuromonitoring peripheral nerve entrapment |
| url | https://www.imrpress.com/journal/CEOG/50/9/10.31083/j.ceog5009198 |
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