JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY
Online ISSN : 1884-5746
Print ISSN : 1884-9938
Case report
Laparoscopic hypogastric nerve transection for dysmenorrhea and pelvic pain associated with endometriosis: case report
Satoshi TanimuraTakashi HosonoHiroshi FunamotoSatoshi TakedaYasushi ShitanoYuka Ametani
Author information
JOURNAL FREE ACCESS

2016 Volume 32 Issue 1 Pages 230-235

Details
Abstract

Objective: Two types of nerve transection have been used to treat endometriosis-related pain at the time of laparoscopic conservative procedure. However, laparoscopic uterosacral nerve ablation (LUNA) carries the risk of causing parasympathetic nerve damage and has been reported to provide no pain relief. Conversely, although laparoscopic presacral neurectomy(LPSN) has been proven to achieve additional pain relief, it has a high level of technical difficulty and is associated with issues such as hemorrhage, constipation, or urinary urgency. Theoretically, the ablation of the left and right hypogastric nerves just before the inferior hypogastric plexus, where the sympathetic and parasympathetic nerves branching from the superior hypogastric plexus meet, makes it possible to selectively and safely resect only the sympathetic nerves. However, this surgical technique has not been reported. In this paper, we report a case of laparoscopic hypogastric nerve transection (LHNT).

Case: A 45-year-old, nulliparous woman presented with menstrual pain, chronic pelvic pain, and an endometriotic cyst in her left ovary. Laparoscopic left adnexectomy, ablation of the endometriotic lesion on the peritoneum, and bilateral LHNT were performed. Postoperative evaluation after 6 months indicated that the pain had improved, and no episodes of urinary urgency or newly developed constipation were observed.

Conclusions: Hypogastric nerves could be laparoscopically identified. LHNT was a feasible procedure and did not cause any clear impairments to urinary or bowel function. The results suggest that LHNT in combination with the currently performed endometriotic lesion removal in patients for whom postoperative hormonal agent use is difficult could reduce endometriosis-associated pain.

Content from these authors
© 2016 Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy
Previous article Next article
feedback
Top