What luck to have experienced two revolutions! More than 20 years ago, when I was still a young gynecologist, I was lucky enough to be an active witness – and not just a passive observer – at the birth of laparoscopic gyneco-oncology. My first laparoscopic lymphadenectomy took place in 1992 with Denis Querleu, and the second with Joel M. Childers. I learnt radical vaginal surgery from Daniel Dargent in 1993. Back then there were no limits, and the goal was to make everything possible via laparoscopy. Thanks to new developments in surgical instruments and video technology, the radicality of laparoscopic pelvic surgery has been greatly improved. One of the side effects, so to speak, was unfortunately an increase in functional morbidity. To reduce or even prevent the latter, instead of reducing radicality we returned to the roots of surgery: the beloved discipline of anatomy. It very quickly emerged that laparoscopy is the ideal tool for improving our understanding of, learning about and investigating pelvic neuro-anatomy. Textbooks and cadaver dissections have helped to significantly improve our knowledge of topographical anatomy and have helped us to apply these skills in our laparoscopic interventions. In order to better determine the function of the nerves intraoperatively, we introduced a technique of intraoperative nerve stimulation, known as the LANN technique. This marked the birth of neuropelveology. Improvements over the years have constantly benefited surgery. Neuropelveology is the key. It has led to nerve-sparing methods in gynecology. Laparoscopic interventions have since been on the increase and have a wide range of uses, from neurosurgery on the pelvic nerves to neuro-functional procedures in neuroprosthetics in pelvic nerves, known as the LION procedure.
This development inevitably increased awareness of the fact that pelvic nerve diseases are much more common than previously assumed. Nerves do not reside as inert structures; they begin to tell their own stories. What was missing, however, was a method for diagnosing such diseases. Consequently, there has been rising interest in diagnostic neurology and neuro-urology. Diagnostics in neuropelveology result from the synthesis of information gained from various medical disciplines (gynecology, neuro-urology, neurology, neurosurgery, etc.).
All these aspects pave the way for and are components of neuropelveology. Despite the immense amount of commitment and curiosity required, it is well worth the effort for our patients. Neuropelveology is attracting growing interest from an increasing number of experts from various disciplines – hopefully including you, honorable colleagues. The foundation stones of neuropelveology have been laid. Young neuropelveologists should remain critical, extend and broaden their knowledge, and time and again raise questions. The aim is to gain a better understanding of the functions and interactions of the pelvic nerves and plexuses, and to respect these and consequently improve the treatment of related diseases. Whether ISON is ultimately a “comet of the century” depends on us and, most of all, on the forthcoming generations of young and inquisitive medical professionals.
Last but never least, let me express a sincere and honest thank you to our friends, the founding members and advisory board, who have invested time, health, money and a wealth of passion to bring life to the International Society of Neuropelveology.