Paracervical uterine denervation by transection of the cervical plexus for the relief of dysmenorrhea

The uterosacral complex: ligament or neurovascular pathway? Anatomical and histological study of fetuses and adults

“…Some authors use the USLC as a ligament, a suspension for reconstructive pelvic organ prolapse surgery, while others excise it for nerve ablation in the treatment of pelvic pain [22,23]. Doyle [22] showed that by excising the USLC close to the cervix, it was possible to "cure" 86% of primary dysmenorrheas and 86.8% of secondary dysmenorrheas. Forty-five percent of the laparoscopists in the UK practice a surgical procedure called laparoscopic uterosacral nerve ablation (LUNA) in the treatment of pelvic pain [23].…”

Investigation of the Localization of Nerves in the Uterosacral Ligament: Determination of the Optimal Site for Uterosacral Nerve Ablation

“…On the other hand, the parasympathetic nerves from S1-S4 are included in the nerve erigentes, and they run for a short distance inside the uterosacral ligament in the lateral part of the pelvis and then Fujii/Sagae/Sato/Tsugane/Murakami/Kudo form ganglia on each side of the uterus (Frankenhauser ganglia) [7]. In terms of treatment modalities, and in particular surgical approaches, there are therefore two methods for cutting off pain-conducting nerve pathways in the pelvis: (1) presacral neurectomy involving cutting the Th10-L1 sympathetic nerves on the anterior surface of the sacrum bone [8], and (2) paracervical uterine denervation involving transection of the uterosacral ligament at its attachment to the uterus along with the above mentioned sympathetic nerves as well as the S1-S4 parasympathetic nerves, which transmit pain stimuli from the supravaginal region and to the uterine cervix [9].…”

“…Black et al reported that presacral neurectomy is effective in 75-80% of dysmenorrhea cases [8]. Doyle et al reported that improvement was seen in 95% of 73 cases of intractable dysmenorrhea treated by paracervical uterine denervation using either the abdominal or vaginal approach [9]. Furthermore, in recent years, there have been many reports on the use of these neurectomies by laparoscopic surgery, with success rates of 82% reported by Lichten [10] and similar high success rates reported by Perez [11] and other authors [12].…”

Bladder dysfunction after repeat laparoscopic uterine nerve ablation (LUNA)

“…Counsellor noted that the sympathetic fibers entered the uterus through the uterosacral ligaments [11]. It is, however, likely that a proportion of uterine afferents in women lie outside the uterosacral ligaments, thus accounting for postoperative failures of both open and laparoscopic uterosacral denervation procedures [2,12].…”