Pudendal neuralgia (PN), defined as chronic pudendal nerve entrapment (PNE), is a painful condition that impairs quality of life (1). The most frequent etiology of PN is pudendal nerve entrapment (PNE) between the the sacrospinous and the sacrotuberous ligaments at the level of the ischial spine and entrance to Alcock canal (2). Management of PN include medication management, physiotherapy, nerve blocks, decompression surgery and neuromodulation, but the most appropriate treatment for PN has not yet been determined. Different surgical approaches include  transperineal, transgluteal, and via the ischiorectal fossa, and more recently the laparoscopic approach has been described  (3). The purpose of this video is to present the laparoscopic pudendal nerve decompression technique in a patient with pudendal nerve compression.

A 31-year-old female patient who was admitted to our clinic with chronic pain after falling in the perineal region and did not benefit from conservative treatments and pharmacotherapy was diagnosed with left PNE using Nantes criteria.
It was entered with 5 trocars in the Trendelenburg position. The peritoneum over the ureter and external iliac vein was dissected. A peritoneal window was created medial to the obturator nerve. The sacrospinous ligament was dissected and the pudendal artery, nerve, and vein passing through the Alcock canal were identified. A drain was placed in the loja.

The operation time was 180 minutes. The amount of bleeding was 100cc. The drain was withdrawn on the second postoperative day, as it did not come from the drain. The patient, who had no problem with follow-up, was discharged on the postoperative 3rd day.
At the 3-month and 1st year follow-up, it was observed that the patient's pain was gone, her quality of life increased and she returned to her normal life.

The laparoscopic approach in PN is an appropriate approach that requires substantial knowledge of pelvic anatomy. It allows us to visualize the relationship of the pudendal nerve with vascularization and connective pelvic structures, allowing its decompression and safe release.

Benson JT, Griffis K. Pudendal neuralgia, a severe pain syndrome. Am J Obstet Gynecol. 2005 May;192(5):1663-8. doi: 10.1016/j.ajog.2005.01.051. PMID: 15902174.
Loukas M, Louis RG Jr, Hallner B, Gupta AA, White D. Anatomical and surgical considerations of the sacrotuberous ligament and its relevance in pudendal nerve entrapment syndrome. Surg Radiol Anat. 2006 May;28(2):163-9. doi: 10.1007/s00276-006-0082-3. Epub 2006 Feb 7. PMID: 16463079.
Erdogru T, Avci E, Akand M. Laparoscopic pudendal nerve decompression and transposition combined with omental flap protection of the nerve (Istanbul technique): technical description and feasibility analysis. Surg Endosc. 2014 Mar;28(3):925-32. doi: 10.1007/s00464-013-3248 1. Epub 2013 Oct 23. PMID: 24149853.