Fellowship in Pelvic Neurosurgery

Conventional treatments such as physical therapy, medications, nerve blocks, and steroid injections often provide only temporary relief because they do not address the underlying structural and inflammatory causes of nerve compression. Similarly, traditional surgical approaches may focus on decompressing a single nerve without identifying or treating the broader network of affected nerves or the inflammatory source. As a result, symptoms frequently persist or recur.

Robotic-assisted neuropelvic surgery represents a significant advancement in the treatment of lumbosacral plexopathy. This approach allows surgeons to access the deep pelvic and greater sciatic regions from within the abdomen using minimally invasive techniques. The robotic platform provides high-definition, magnified visualization, enabling precise identification of nerve structures and surrounding pathology. This level of access and visualization is not achievable with traditional external approaches.

Robotic surgery enables comprehensive treatment of the underlying condition by removing inflammatory nodules, releasing fibrotic adhesions, and performing precise neurolysis to free affected nerves. In addition, it allows for decompression of confined anatomical spaces, including release of restrictive ligaments when necessary. This approach also facilitates evaluation and treatment of associated conditions such as endometriosis and allows assessment of both somatic nerves and autonomic structures, including the inferior hypogastric plexus.

Traditional surgical techniques, such as transgluteal or transperineal approaches, provide limited visualization and access to deep pelvic structures. These methods often address only a portion of the problem and may fail to identify the underlying cause of nerve compression. In contrast, robotic surgery allows for a comprehensive evaluation of the entire lumbosacral plexus and surrounding anatomy, enabling more precise and complete treatment with minimal disruption to surrounding tissues and reduced blood loss.

Patients who experience persistent deep gluteal pain, buttock pain, pelvic pain, or low back pain that does not respond to standard treatments may be candidates for further evaluation. This is particularly relevant for individuals with complex or radiating pain patterns, a history of endometriosis, prior pelvic surgery, or unexplained chronic pelvic pain. A thorough clinical and diagnostic assessment is essential to determine candidacy.

With over 20 years of experience in complex pelvic surgery and a focused expertise in pelvic nerve surgery over the past decade, Dr. Shakiba is a recognized leader in neuropelvic surgery. His approach integrates advanced robotic technology with a deep understanding of pelvic neuroanatomy, allowing for comprehensive evaluation and treatment of conditions that are often misdiagnosed or inadequately managed. This expertise provides patients with a highly specialized and effective pathway toward long-term relief.