The information provided by Advanced Healthcare for Women and E. Daniel Biggerstaff, III, M.D. is for informational purposes only. As each woman is unique, do not rely on this information for diagnosis and treatment. We cannot guarantee the accuracy of the content and advise that you see a qualified Health Care Professional for individual needs and care.
Advanced Treatment: Laparoscopic Presacral Neurectomy
Severe pelvic paiin and menstrual cramps in the lower middle of the abdomen can be difficult to treat. One of the most common causes for severe menstrual (and premenstrual) cramping is endometriosis. On occasion, endometriosis can develop in the muscular wall of the uterus -- this is called adenomyosis.
Adenomyosis can cause severe pain in the lower mid abdomen and pelvis, and there are only two ways to effectively treat it: removing the uterus (hysterectomy) or interrupting the nerves going to the uterus (presacral neurectomy).
Until the late 1980's, presacral neurectomy required a large abdomin incision, a so-called laparotomy. Techniques and equipment were developed, so the procedure could be performed laparoscopically . Laparoscopic presacral neurectomy is performed under general aneathesia. The surgeon uses a video laparoscope, placed through a small incision, usually in the belly button. Several (usually three) small incisions are made above the pubic hairline, so other instruments needed to perform the procedure can be inserted. During the procedure, nerve tissue that goes to and from the uterus is interrupted in the area where the lower spine and tailbone meet (the sacral promontory). This is the best area to access the nerves to the uterus. Other surgical procedures such as excision of endometriosis, if appropriate, may be performed at the same time as a presacral neurectomy.
The sacral promontory is surrounded by major blood vessels, the ureters that connect the kidneys to the bladder, and the intestines,so very careful, precise surgical technique is necessary to avoid unnecessary complications. The area outlined in green indicates the area where the nerve tissue is removed.
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