Robot-Assisted Exploration of the Alcock Canal: A Novel Surgical Technique

Abstract

Study Objective

To demonstrate a safe and reproducible surgical approach to the Alcock canal with a full decompression of the pudendal nerve.

Design

The technique is demonstrated step-by-step with narrated video footage.

Setting

Pudendal neuralgia, a condition causing debilitating pelvic pain, is traditionally managed through a transgluteal incision [1,2]. This surgical approach offers limited visualization and ability for nerve decompression [3]. With the current technique, a full exposure and decompression of the pudendal nerve was achieved.

Interventions

A 44-year-old para 2 presented with burning vaginal pain radiating to the left groin that was aggravated with sitting. She underwent a robotic-assisted left sacrospinous ligament transection and fasciotomy of the obturator internus muscle for suspected pudendal neuralgia. The surgery was performed with 3 robotic ports using the da Vinci Xi robotic system.

Conclusion

With the enhanced access to the pudendal nerve provided by the novel surgical technique demonstrated in this study, a more comprehensive nerve decompression can be performed. This technique was successfully applied to a patient with pudendal neuralgia. There were no immediate intra- or postoperative complications. In short-term follow-up, the patient had significant relief of preoperative symptoms. Although all surgical procedures for pudendal neuralgia have a risk of pudendal nerve and vessel injury [4], the presented technique has the potential to limit these risks by providing an enhanced view of the relevant anatomy. Future adaptation and refinement of this technique may contribute to the advancement of the surgical management of pudendal neuralgia.

Video Abstract

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