ANATOMIC APPROACH TO LAPAROSCOPIC PRESACRAL NEURECTOMY

T. Lee

Magee Women’s Hospital, Pittsburgh, PA

OBJECTIVE:  To demonstrate the anatomic approach for safe and effective execution of laparoscopic presacral neurectomy. 

MATERIALS AND METHODS: All patients with known or suspected endometriosis were counseled regarding laparoscopic presacral neurectomy as an adjuvant to laparoscopic excision for the treatment of pelvic pain associated with endometriosis.   Risks and benefits of the presacral neurectomy were explained to the patients.  Informed consents were obtained before laparoscopic presacral neurectomies were performed.  The common iliac arteries marked the lateral borders of the dissection.  Inferior mesenteric artery crossing over both left common iliac artery and vein serves as a useful landmark for defining the left border of the dissection.  The right common iliac artery is easily seen.  The plane between the superior hypogastric plexus, left common iliac vein and periosteum of sacral promontory is developed.  2-3 cm segment of superior hypogastric plexus/presacral nerve is resected and sent to pathology for confirmation.  All laparoscopic presacral neurectomies were performed safely without any vascular complication using this anatomic approach.  All specimens from the presacral neurectomy confirm the presence of nerve bundles, ganglions with occasion lymph nodes. 

CONCLUSION:  Clear understanding of the presacral anatomy facilitates safe and effective execution of laparoscopic presacral neurectomy. 

Key Words: laparoscopic presacral neurectomy, superior hypogastric plexus, pelvic denervation.       

Disclosure – Nothing to disclose.