Laparoscopic presacral neurectomy vs neurotomy: use of the argon beam coagulator compared to conventional technique

Presacral neurectomy is effective treatment for dysmenorrhea and midline pelvic pain. Conventional laparoscopic techniques describe retroperitoneal dissection to excise retroperitoneal nerve tissue. The argon beam coagulator (ABC) can be used laparoscopically to hemostatically ablate and thus separate the presacral tissues down to the periosteum without dissecting or excising tissue. In 32 patients undergoing laparoscopic presacral neurectomy, 17 were performed with conventional methods, and 15 patients underwent ABC neurotomy only, without dissection or excision. Postoperative pain reduction was the same in both groups (73% vs 75%), with average anesthesia time 64 min for ABC neurotomy vs 92 min with conventional techniques. One major vascular complication requiring immediate laparotomy occurred in the ABC group. When properly applied laparoscopically, the ABC is an effective tool to rapidly coagulate and separate the presacral nerves with minimal smoke, excellent visualization, and no retroperitoneal dissection.