Transgluteal Laparoscopic Piriformis Muscle Transection: A Novel Minimally Invasive Approach for Chronic Pelviperineal Pain Syndrome.

BACKGROUND: Piriformis muscle syndrome (PMS) is an underrecognized cause of chronic pelvic and gluteal pain, representing a diagnostic and therapeutic challenge in clinical practice. It results from entrapment of neurovascular structures adjacent to the piriformis muscle. Surgical intervention is reserved for patients with refractory symptoms unresponsive to conservative management. Although minimally invasive approaches to the deep gluteal space have evolved, laparoscopic piriformis muscle transection remains underreported. OBJECTIVE: To describe a novel transgluteal laparoscopic technique for selective piriformis muscle transection, detailing the relevant anatomical landmarks and step-by-step operative approach. RESULTS: A retrospective analysis of 200 patients who underwent this operation by a single surgeon in multiple institutions demonstrated that the procedure is technically feasible, reproducible, and safe, with minimal blood loss, low perioperative morbidity, and short hospital stay. CONCLUSION: Transgluteal laparoscopic selective piriformis muscle transection offers a safe minimally invasive option for selected patients with refractory PMS. Further prospective and comparative studies are required to define its long-term clinical and functional outcomes.