Targeted Robotic Neurolysis for Groin and Testicle Pain

[jon]

I'm not sure why I didn't find this doctor sooner. Rather than spending my life's savings on two surgeries with Dr. Dellon, this may have been a better way for me to have gone.

Here is what Dr. Sijo Parekattil wrote to me:

"We may be able to help - we could try a targeted mapped ilioinguinal & inferior hypogastric block to see if you get any response, and if you do, then we could try a robotic assisted targeted intra-abdominal denervation of the spermatic cord. Other options if you failed this, would then be targeted botox blocks and then finally possible targeted mapped microsurgical cryoablation of these nerves. If you are interested in trying our options, feel free to call our office at 863-292-4652 and you can speak to Jessica, our nurse practitioner to make arrangements. We could have you fly down here to see us on a Monday, do the targeted block on Tuesday, f/u w/ me on Wed, then proceed with robotic abdominal neurolysis/denervation on Thursday (if you responded to the block) and you could fly back Friday or Saturday. These procedures are usually covered by insurance and our office could arrange this for you. These are all outpatient procedures.
I will send you a separate email with some of our general info and details of our denervation techniques".

Here is a link to the portion of their website that deals with testicular pain at their clinic and a small clip from a paper written by Dr. Sijo Parekattil in Winter Haven, Florida.



Single port and abdominal robotic
microsurgical neurolysis for phantom groin
pain after orchiectomy or persistent
orchialgia after denervation of the spermatic
cord

Chronic groin pain can be debilitating for patients. Microsurgical
subinguinal denervation of the spermatic cord
(MDSC) is a treatment option for this pain. However,
there are limited further options for patients who fail this
treatment or who have phantom pain after orchiectomy.
Our goal was to develop a single port and abdominal
robotic microsurgical neurolysis technique to ligate the
genitofemoral and inferior hypogastric nerve fibers within
the abdomen above the internal inguinal ring.
We performed a prospective study of patients with
chronic groin pain who had either failed previous MDSC
or had phantom pain after orchiectomy. Primary endpoint
was impact of pain on quality of life (PIQ-6 pain impact
questionnaire from RAND) and secondary endpoint was
operative robotic duration. PIQ-6 scores were collected
preop and at 1, 3, 6 and 12 months postop.
We completed 30 cases (five single port) from June
2009 to September 2010. Elimination of pain occurred
in 60% (18 cases) and a greater than 50% reduction in
pain occurred in an additional 13% (four cases) within
1 month postop. Two of the failures were patients
who had pain elimination for 6 months but then pain
returned thereafter. Median odds ratio duration was
10 min (5–30). There were three complications: one
postop scrotal hematoma that resolved with conservative
measures, one patient had pain at one of the port
sites and one patient had pain that shifted from the
groin to the leg.

[nyt]

Thanks for this information!

[Violet M]

Jon, cryoablation can be an effective treatment for people in which a sensory nerve is the culprit and sounds like it could be worth a try for you. I think "acw" had a successful similar surgery -- can't remember if it was the ilioingunial or genitofemoral nerve. Too bad this type of treatment can't be used on the pudendal nerve though.

Best wishes if you try this surgery and please let us know how it goes for you.

Violet

[acw]

Violet, you have a good memory (or effective search). I had cryoablation of the ilioinguinal nerve. I'm always more than happy to share my experience and answer any questions about it.

[Violet M]

No, I've just been around too long. Thanks for the clarification, acw.

Violet

[jon]

The perineal branch of the pudendal can be cut, so I'm pretty sure cryoblation would work there too.

I am still planning to make the trip to see Dr. Parekattil, maybe this summer.

[jon]

I just saw I never came back with an update here.

I was really impressed by Dr. Sijo Parekattil and his clinic.

Under full, general anesthesia, I had over 30 targeted, robotic injection to block pain, as a diagnostic. I was not helped.

Still disabled at age 59. Thank God for my private disability insurance. Even though they cut me off a few years back, and I had to use a lawyer and see several of his specialists, at a cost of $20,000. And thank God for credit cards! They have left me alone ever since, although I'm always paranoid I will have their investigators following me around filming me - again. All I need is to be having a good day and get filmed doing something above and beyond what I said I am capable of on their questionnaires. Highly unlikely, unfortunately.