OBJECTIVE: To report the feasibility, description of technique, and operative outcomes of robot-assisted laparoscopic presacral neurectomy.DESIGN: Prospective case series of 17 patients with central pelvic pain and history of endometriosis who underwent robot-assisted laparoscopic presacral neurectomy from July 2006 to April 2008.MATERIALS AND METHODS: With the patient under general endotracheal anesthesia, a 12 mm intra-umbilical cannula and two 8 mm lateral ports were introduced into the peritoneal cavity for use of the da Vinci® system. The patient was placed in steep Trendelenberg position and tilted to the left. Due to the cephalad position of the interiliac triangle, as well as unique docking of the surgical cart of the da Vinci® system, the lateral ports were placed 1-2 cm above the anterior superior iliac spine for introduction of fenestrated Maryland bipolar Endowrist™ or Endowrist™ Precise™ bipolar on the left side and monopolar Hot Shears™ on the right. An additional 5 mm port was placed suprapubically for introduction of suction-irrigator, grasping forceps and tissue extraction. Triangle of Cotte anatomical landmarks were identified. The posterior peritoneum was incised at the sacral promontory. The interiliac trianle was stripped of aereolar and lymphatic tissue with exposure and excision of the superior hypogastric nervous plexus.RESULTS: Patients mean age, gravidy, and parity were 27.6, 0.5, and 0.2, respectively. Approximate mean duration of the procedure was less than 10 minutes. Mean estimated blood loss for the entire procedure was less than 30cc. Presence of nerve ganglion and fibers was confirmed by pathology in all 17 cases. At the time of analysis, follow-up ranged from 2 to 16 months. No short-term or long-term complications related to the surgical procedure were reported. All patients reported improvement of pelvic pain.CONCLUSIONS: Ergonomics of computer enhanced remote surgery create the intuitive invironment similar to laparotomy. The surgical robot provides wide angle and 3-D vision, supplemented with magnification. Bimanual manipulation of multifunctional devices and downscaled motion is tremorless. With the help of robotic technology, laparoscopic presacral neurectomy is feasible and can help the surgeon to overcome intrinsic limitations of laparoscopy and avoid modifications, which result invariably in suboptimal outcomes, thereby bridging the gap between laparotomy and laparoscopy. OBJECTIVE: To report the feasibility, description of technique, and operative outcomes of robot-assisted laparoscopic presacral neurectomy. DESIGN: Prospective case series of 17 patients with central pelvic pain and history of endometriosis who underwent robot-assisted laparoscopic presacral neurectomy from July 2006 to April 2008. MATERIALS AND METHODS: With the patient under general endotracheal anesthesia, a 12 mm intra-umbilical cannula and two 8 mm lateral ports were introduced into the peritoneal cavity for use of the da Vinci® system. The patient was placed in steep Trendelenberg position and tilted to the left. Due to the cephalad position of the interiliac triangle, as well as unique docking of the surgical cart of the da Vinci® system, the lateral ports were placed 1-2 cm above the anterior superior iliac spine for introduction of fenestrated Maryland bipolar Endowrist™ or Endowrist™ Precise™ bipolar on the left side and monopolar Hot Shears™ on the right. An additional 5 mm port was placed suprapubically for introduction of suction-irrigator, grasping forceps and tissue extraction. Triangle of Cotte anatomical landmarks were identified. The posterior peritoneum was incised at the sacral promontory. The interiliac trianle was stripped of aereolar and lymphatic tissue with exposure and excision of the superior hypogastric nervous plexus. RESULTS: Patients mean age, gravidy, and parity were 27.6, 0.5, and 0.2, respectively. Approximate mean duration of the procedure was less than 10 minutes. Mean estimated blood loss for the entire procedure was less than 30cc. Presence of nerve ganglion and fibers was confirmed by pathology in all 17 cases. At the time of analysis, follow-up ranged from 2 to 16 months. No short-term or long-term complications related to the surgical procedure were reported. All patients reported improvement of pelvic pain. CONCLUSIONS: Ergonomics of computer enhanced remote surgery create the intuitive invironment similar to laparotomy. The surgical robot provides wide angle and 3-D vision, supplemented with magnification. Bimanual manipulation of multifunctional devices and downscaled motion is tremorless. With the help of robotic technology, laparoscopic presacral neurectomy is feasible and can help the surgeon to overcome intrinsic limitations of laparoscopy and avoid modifications, which result invariably in suboptimal outcomes, thereby bridging the gap between laparotomy and laparoscopy.