Laparoscopic presacral neurectomy. Results of the first 25 cases.

Since the 1960s, medical therapy utilizing nonsteroidal antiinflammatory drugs and oral contraceptives with the addition of danazol and gonadotropin releasing hormone have become the treatment of choice for chronic pelvic pain and dysmenorrhea. The surgical approach to this problem, incorporating interruption of the superior hypogastric nerve plexus (presacral neurectomy), therefore, has become less popular. Investigations, however, have demonstrated that 20-25% of patients treated medically for this problem fail to show an improvement. As a result, attention has turned once again toward surgical treatment for those who have failed to respond to medical management. Laparoscopic uterosacral nerve ablation, or laparoscopic uterine nerve ablation, appears to offer hope in this regard and represents a return to a surgical approach for conservative management of severe, disabling dysmenorrhea and pelvic pain in women who have failed medical treatment. Since there has been such an emphasis on outpatient treatment and surgery, a laparoscopic approach to the classic presacral neurectomy was devised and implemented.