Research Information System
34th Annual Congress of the European Society for Gynaecological Endoscopy (ESGE), İstanbul, Turkey, 19 - 22 October 2025, pp.1, (Full Text)
Background
To present the anatomical landmarks of a standardized and reproducible surgical approach enabling
laparoscopic sciatic nerve dissection utilising the ‘’ medial’’ approach.
Methods
Narrated surgical video. Local institutional review board not required, patient consent was obtained.
The sciatic nerve can be compressed by several gynaecological and obstetrical causes leading to
sciatica, with endometriosis being the commonest gynaecological aetiology. Sciatic nerve dissection
can be performed laparoscopically via a ‘’lateral’’ or a ‘’medial’’ approach. The ‘’lateral’’ approach
utilises a plane of dissection lateral to external iliac vessels, whereas, in the ‘’medial’’ approach, the
surgeon dissects medially to the external iliac vessels. 28-year-old patient with chronic pelvic pain
radiating to the posterior aspect of her right lower limb. Pre-operative imaging did not identify any
pathology accounting for her symptomatology, however, due to the severity of symptoms, an
exploratory laparoscopy was decided upon.
Results
Laparoscopic sciatic nerve dissection utilising the ‘’medial’’ approach can be performed by following
these steps: 1. Horizontal incision of the peritoneum, parallel to the gonadal vessels, in the triangle
that is formed by the adnexa, the external iliac vessels and the round ligament. 2. Identification of
the ureter that is kept on the medial border of the dissection plane. 3. Identification of the obturator
nerve and vessels laterally. 4. Deepening the dissection caudally, to reach the hypogastric vein.
Careful skeletonization of this vessel is necessary to avoid haemorrhage. 5. Fine dissection lateral and
caudal to the hypogastric vein leads to the identification of the lumbosacral trunk and sciatic nerve.
Conclusions
The ‘’medial’’ approach described here represents a safe and standardized approach to dissect the
sciatic nerve laparoscopically, employing a dissection plane medial to the external iliac vessels.
https://player.vimeo.com/video/1085650679?autoplay=1