Laparoscopic presacral neurectomy utilizing contact-tip Nd: YAG laser.

Abstract

The performance of the presacral neurectomy with a standard laparoscopic approach utilizing a Contact-tip Nd: YAG Laser with the GRP6 sapphire scalpel tip is feasible, effective, and safe. Patients suffering from severe disabling dysmenorrhea have had complete relief of their symptoms with up to an eighteen-month follow up. The resection of the presacral nerve plexus is associated with significant relief of symptoms. The pain impulses from the uterus which travel through the inferior hypogastric plexus into the intermediate hypogastric plexus and the superior hypogastric plexus can be interrupted by the performance of this procedure in a laparoscopic manner. The intermediate hypogastric plexus which is composed of two or three trunks lying on the vertebral body of L5 is the most appropriate place for the resection. The presacral neurectomy is not appropriate treatment for relief of lateral or back pain. Patients with midline pain will experience significant relief by the use of this procedure. In conclusion, the performance of the presacral neurectomy utilizing the Contact-tip Nd: YAG Laser with GRP6 sapphire tip combined with other conservative surgery for resection of endometriosis does offer relief of dysmenorrhea and other pelvic pain and is an alternative for women wishing further childbearing and those who do not wish a hysterectomy. Twenty women in whom this procedure has been performed have reported a decrease in pain level from 9.4 (scale of 0 = no pain to 10 = disabling pain) to 2.0 with follow up to 18 months. There have been no complications with this procedure.