Robot-Assisted Laparoscopic Neurolysis for Fibrotic Entrapment of the Lumbosacral Plexus in Post-Traumatic and Iatrogenic Chronic Pelvic Pain.

OBJECTIVE

To describe the technical feasibility and early outcomes of robot-assisted laparoscopic neurolysis (RALN) of the lumbosacral plexus in patients with chronic neuralgias secondary to post-traumatic or iatrogenic fibrosis.

SETTINGS: The study was conducted in a tertiary referral center specializing in advanced robotic surgery and neuropelveology for chronic pelvic pain syndromes.

PARTICIPANTS

Series of 11 procedures performed between 2024 and 2025. All patients had failed earlier multidisciplinary medical management. Lumbo-sacral fibrosis was secondary to post-traumatic (5 cases) or iatrogenic hematomas (4 cases). The diagnosis of nerve compression was confirmed by clinical examination, pelvic MRI, and a targeted lidocaine block showing >50% pain relief with dermatomal anesthesia as described in pudendal neuralgia protocols [1].

INTERVENTIONS: We illustrate our series with the case of a 41-year-old woman who developed a chronic hematoma following a left sacrospinous ligament fixation for prolapse repair. Progressive fibrosis resulted in refractory sciatic, posterior femoral cutaneous, and pudendal neuralgias, with associated motor, sensory, and vegetative disturbances. A RALN of the lumbosacral plexus was performed using a standardized four-step technique, adapted from our previously described pudendal approach and other published methods [2-5]. Intraoperative video documentation was used to detail the procedure. Postoperative care followed an enhanced recovery protocol. Early results at 4 months of follow-up reported improvement in pain, ambulation, and seating tolerance. Two Clavien-Dindo 1 complications were reported. A 1-year follow-up is planned to assess sustained recovery and nerve regeneration.

CONCLUSION

RALN of the lumbosacral plexus appears to be a feasible approach for selected cases of chronic pelvic pain caused by post-traumatic or iatrogenic fibrotic entrapment. This advanced technique should be reserved for specialized centers with expertise in neuropelveology and carries a potential risk of neurovascular complications. VIDEO ABSTRACT.