The Laparoscopic Implantation of Neuroprothesis (LION) Procedure to Control Intractable Abdomino-Pelvic Neuralgia.

Objective.  To present different aspects and advantages of the laparoscopic implantation of a peripheral nerve stimulator adjacent to the pelvic nerves, aimed at treating intractable pelvic neuralgia by means of neuromodulation-the laparoscopic implantation of neuroprothesis (LION) procedure. Materials and Methods.  We report here a series of three patients with different types and etiologies of chronic pelvic neuralgia who underwent laparoscopy for implantation of a peripheral nerve stimulator for neuromodulation, the first for neuromodulation of the ilioinguinal and pudendal nerves, the second for neuromodulation of the sciatic nerve, and the third for neuromodulation of the sacral nerve roots. In all three patients, the neuralgia was refractory to medical management and had profound socioeconomic consequences for the patients. Results.  Laparoscopic implantation of neuroelectrodes was successfully performed in all three patients and resulted significant diminution of pain without need for further medical treatment. Conclusions.  Laparoscopy allows optimal implantation of electrodes on all pelvic nerves through a minimally invasive approach. In addition, it permits new applications of neuromodulation for pelvic polyneuropathies or mononeuropathy, not covered by classical spinal cord or transcutaneous techniques.