Robotic
Pudendal Nerve
Decompression
The pudendal nerve plays a critical role in pelvic sensation and function. Our robotic-assisted approach allows precise identification and decompression of the nerve in areas beyond the reach of traditional surgery.
Understanding the Condition
What Is Pudendal Nerve Entrapment?
Pudendal nerve entrapment occurs when the nerve is compressed along its course, most commonly within Alcock’s canal or at the level of the sacrospinous and sacrotuberous ligaments. In many patients, this compression is driven by underlying inflammation, fibrosis, or endometriosis involving the pelvic sidewall.
Symptoms
Why This Happens
Why Traditional Treatments Fail
Our Surgical Approach
Symptoms
Patients may experience:
- Burning, sharp, or electric pain in the perineum
- Pain with sitting (classic hallmark)
- Pain radiating to vagina, rectum, or clitoris
- Dyspareunia
- Urinary urgency or frequency
- Bowel dysfunction or painful defecation
Why This Happens
The most common causes include:
- Deep infiltrating endometriosis
- Post-surgical scarring
- Chronic pelvic inflammation
- Ligamentous compression (sacrospinous / Alcock canal)
Why Traditional Treatments Fail
Many conventional approaches focus on surface-level treatments such as physical therapy, medications, or nerve blocks. While helpful in some cases, they often do not address deep intrapelvic nerve compression, which requires direct visualization and surgical release.
Our Surgical Approach
We utilize a robotic intrapelvic approach, which provides unparalleled visualization and access to the deep pelvic neuroanatomy. This technique allows:
- Direct visualization of the pudendal nerve and pelvic neuroanatomy
- Precise nerve decompression with minimally invasive robotic surgery
- Release of Alcock’s canal and surrounding adhesions
- Treatment of adjacent lumbosacral plexus nerves when needed
- Comprehensive approach to neuropathic pelvic pain
A key advantage of this approach is the ability to achieve direct access and excellent visualization of the entire greater sciatic region. This significantly expands the scope of treatment beyond isolated pudendal nerve decompression.
Through this extended exposure, it becomes possible to evaluate and, when indicated, address adjacent neural structures within the lumbosacral plexus, including regions contributing to:
- Low buttock pain
- Posterior thigh pain
- Radiating neuropathic pelvic pain
These symptoms are often related to inflammation or entrapment of nerves such as the posterior femoral cutaneous nerve and perforating cutaneous nerve, which travel in close proximity to the pudendal nerve.
This comprehensive approach allows for:
- Assessment of the broader neural network
- Release of adhesions affecting multiple nerve pathways
- Reduction of diffuse neuroinflammatory burden within the pelvis
As a result, when clinically indicated, surgery is not limited to a single nerve but instead provides a global decompression strategy of the lumbosacral plexus, addressing the full spectrum of neuropathic pelvic pain generators.
The Surgical Journey
What to Expect
01
Minimally invasive robotic procedure
02
Typically outpatient or short stay
03
Procedure duration varies depending on complexity
04
Immediate decompression achieved at surgery
The Healing Process
Recovery & Nerve Healing
Nerve recovery is gradual:
- Initial improvement may be seen within weeks
- Continued recovery over several months
- Adjunct therapies (medications, neuromodulation, targeted therapy with radiofrequency) may be used to optimize healing
