Surgical Neuropelviology: combined Sacral Plexus Neurolysis and Laparoscopic Laterally Extended Endopelvic Resection in deep Lateral Pelvic Endometriosis

Abstract Objective Surgical demonstration of combined sacral plexus neurolysis and laparoscopic laterally extended endopelvic resection for deep Lateral infiltrating endometriosis Design Video showing principles Neurolysis and laparoscopic laterally extended endopelvic resection applied to endometriotic surgery Setting University tertiary referral center. Deep infiltrating endometriosis is a underestimated disease with a real medical and clinical issue, recently classified as central pelvic endometriosis and lateral pelvic endometriosis further divided into superficial and deep according to structures involvement [1] . Surgical removal of endometriotic foci remain the standard treatment. A wide knowledge of neuroanatomy and high skills in minimally invasive surgery are require to manage this challenging surgical scenario [2] . Interventions New surgical approach for deep lateral infiltrating endometriosis based on principles of lateral extended endopelvic resection and neuropelviological surgey [ 3 , 4 ]. A 35-year-old patient, para 1, with a neurophatic pain irradiated to the left leg and cyclical menstrual disorder . A Laparoscopic-assisted neuronavigation and subsequent neurolysis had allow to identify the lateral nodule without damage the autonomical pelvic innervation [1] . Then, a complete resection of internal vascular compartment was required to obtain a radical endometriotic eradication. Shaving technique and bladder resection were also performed to complete removal of endometriotic foci. Conclusion The association of neuroanatomical knowlodge and surgical oncological principles applied to minimally invasive surgery should be considered to ensure an adequate surgical radicality and clinical benefit in patient with deep infiltrating endometriosis.