Laparoscopic hypogastric nerve transection for dysmenorrhea and pelvic pain associated with endometriosis: case report

Satoshi Tanimura, Takashi Hosono, Hiroshi Funamoto, Satoshi Takeda, Yasushi Shitano, Yuka Ametani
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2016 · vol. 32(1) , pp. 230–235 · doi:10.5180/jsgoe.32.230 · W2575234847
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-08 ⓘ

This paper reports a novel laparoscopic hypogastric nerve transection technique as a potential alternative to LUNA and LPSN for treating endometriosis-related pelvic pain.

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This case report describes a 45-year-old nulliparous woman with menstrual pain, chronic pelvic pain, and a left ovarian endometriotic cyst who underwent laparoscopic left adnexectomy with ablation of peritoneal endometriotic lesions and bilateral laparoscopic hypogastric nerve transection (LHNT). The authors frame LHNT as a theoretical way to transect sympathetic nerves near the inferior hypogastric plexus while avoiding parasympathetic damage associated with LUNA, and they note that prior techniques like LPSN can be difficult and linked to complications such as hemorrhage and bowel or urinary urgency. At 6-month postoperative follow-up, her pain improved and the report states there were no episodes of urinary urgency or newly developed constipation. Limitations include that this is a single case report without a comparator. This paper is centrally about endometriosis—specifically LHNT as an approach used alongside laparoscopic removal/ablation of endometriotic lesions for endometriosis-associated pain.

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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).
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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. © 2016 日本産科婦人科内視鏡学会

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Condition tags

endometriosisdysmenorrhea

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last seen: 2026-06-10T17:14:06.276822+00:00
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