Laparoscopic Presacral Neurectomy
Presacral Neurectomy is the surgical removal of the presacral plexus, the group of nerves that conducts the pain signal from the uterus to the brain. Indicated for the treatment of central pelvic pain including severe dysmenorrhea, it was modified by Dr. Cotte to its current format.
Laparoscopic Presacral Neurectomy (LPSN) is the same procedure done by a minimally invasive method. It is a surgical approach in patients with central dysmenorrheal (painful periods), adenomyosis, and endometriosis.
How Laparoscopic Presacral Neurectomy is Performed
Done through a small umbilical and bikini line incisions, LPSN is carried out by removing the nerve fibers that innervate the uterus, thus blocking the pathways for pain impulses to the brain. LPSN does not cure the pelvic pain that is lateral, which is related to the ovarian or other pelvic sidewall structures.
When performed correctly and in the appropriately chosen patient, the complications PSN are minimal and sometimes include constipation, urinary symptoms, or painless labor.
Central Pelvic Pain
Central pelvic pain (CPP) is reported in about 20 percent of menstruating females. Chronic pelvic pain refers to menstrual or non-menstrual pain of at least six months' duration.
Dysmenorrhea, one of the most frequently reported gynecological problems, is characterized by sharp, intermittent spasms. Symptoms of headache, nausea, vomiting, diarrhea and fatigue are also present. Pain typically begins before or at the onset of menses.
The prevalence of the disorder is highest in adolescents with estimates ranging from 20-90 percent.
Risk factors for the disorder include nulliparity, heavy menstrual flow, smoking, and depression.
Medical therapy for dysmenorrhea includes NSAIDs (such as Motrin) and/or oral contraceptives. Approximately 10-25 percent of women with dysmenorrhea do not respond to medical management and may require surgical intervention, such as presacral neurectomy.
Strict selection of patients and adherence to the established protocol are the requirements for the successful presacral neurectomy (PSN), leading to the reported cure rates between 65 and 80 percent.