“Multimodal neurophysiological monitoring during laparoscopic pelvic nerve decompression in deep endometriosis: results from a prospective single-center cohort”

Objective: To describe the technique and assess the clinical utility of intraoperative neurophysiological monitoring (IONM) during laparoscopic pelvic nerve decompression in women with deep endometriosis, with a focus on its integration into surgical workflow and its role in preserving pelvic neurological function. Methods: A prospective descriptive case series was conducted at a Latin American tertiary center between January 2024 and May 2025. Fourteen women with MRI-confirmed deep endometriosis and pelvic nerve involvement underwent laparoscopic decompression assisted by a multimodal IONM protocol. Data on demographics, intraoperative findings, neurophysiological alerts, and clinical symptoms were recorded. Postoperative outcomes were assessed at 1, 3, and 6 months. Descriptive statistics were applied. Results: All patients exhibited intraoperative evidence of nerve compression, most commonly involving the sciatic (57.1%) and pudendal (50%) nerves. Multimodal IONM was successfully implemented in all cases (100%), with no major intraoperative complications. At 1 month, 78.6% of patients reported symptom improvement, with sustained benefit in 75% at 6 months. No permanent motor deficits were observed, and transient postoperative symptoms were resolved in all cases. The most frequently improved symptoms included dyschezia, urinary dysfunction, and chronic pelvic pain. Conclusion: Laparoscopic pelvic nerve decompression with real-time IONM is a safe and reproducible technique that may enhance surgical outcomes and neurological preservation in patients with deep endometriosis. The present study provides foundational evidence for its systematic incorporation in Latin American surgical practice, though larger and controlled studies are warranted to confirm these findings and evaluate long-term efficacy.