LAPAROSCOPIC NERVE-SPARING TECHNIQUES
Endometriosis is one of the most common gynecological diseases, affecting millions of women and girls around the world. The disease can lead to excruciating pain, infertility and repeated surgery.
Surgery is usually an inevitable part of treatment of patients suspected of having deep infiltrating endometriosis, in which case it serves not only diagnostic, but also therapeutic purposes (provides a means to directly perform treatment, if needed). The surgical procedure consists of the complete eradication of endometriosis while leaving all of the pelvic organs in place and their functions (e.g., fertility) intact. Removal of the uterus or ovaries is not necessary in most cases, and removal would not make sense if the patient wishes to have children at a later point in time. Laparoscopic surgery has established itself as the method of choice for the treatment of endometriosis.
Endometriosis of the rectum, the urinary bladder or of the ureters
Deep infiltrating endometriosis of the rectovaginal septum (space between the rectum and vagina) is one of the most difficult types of endometriosis to treat. Endometriosis often involves the rectum, the ureter, the bladder or even the pelvic nerves that control rectal, bladder and sexual functions. Extensive endometriosis of the rectum can lead to an intestinal occlusion of the bladder to an obstruction of the ureters and thus to irreversible kidney damage and bladder wall destruction. Surgical removal of the endometriosis eventually with removal part of the involved organs is necessary. Such procedures can be performed by laparoscopic or by open approaches. However the laparoscopy provides unparalleled access to all of the pelvic nerves together with the necessary visibility and technology needed for preservation of the nerves or even for complex neurosurgical interventions. The “Laparoscopic Neuro-Navigation (LANN)” technique is the product of this development. Professor Marc Possover proved that the LANN technique and its selective nerve-sparing effects can prevent postoperative nerve dysfunction, even after very extensive surgery.
Endometriosis of the sciatic nerve
It is well known that the urinary and intestinal tracts can be affected by endometriosis. However, it is less commonly known that endometriosis can affect the sciatic nerve and other pelvic nerves. In 2004, Professor Marc Possover started to draw the attention of his colleagues in the fields of neurology, neurosurgery, orthopedic medicine and pain management to the problem of sciatic nerve endometriosis. Patients coming from all countries in the world started to come to him for treatment of sciatic endometriosis. In 2011, Professor Possover reported treating more than 200 cases of endometriosis of the sciatic nerve. It is therefore assumed that this disease is not as rare as previously thought. Moreover, endometriosis can affect all other nerves of the pelvis, including the obturator and femoral nerves.
In pelvic nerves endometriosis, hormone therapy is unhelpful and perhaps even hazardous because it can result in delayed surgical management of the disease. Surgical treatment is always required before irreversible damages to the nerve occur, damages that lead to motor deficits and may particularly affect movements that involve lifting and lowering of the foot.
Because the laparoscopic surgeon must have a sound knowledge of the complex anatomy of the pelvis – especially of the pelvic nerves – and a great deal of skill and experience in surgery, laparoscopic treatment of endometriosis of the sciatic nerve is the most demanding type of pelvic surgery.
The Possover International Medical Center treats all types of endometriosis, from simple to complex. Prof. Possover is specialized in laparoscopic surgery for severe endometriosis and is the world’s leading expert for laparoscopic surgery of endometriosis of the sciatic nerve.