Severe pelvic pain and menstrual cramps that are located 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. Endometriosis is a condition in which tissue similar to that which lines the uterine cavity is found outside of the uterus. This can result in pain and sometimes infertility. On occasion, this type of tissue is found in the muscular wall of the uterus, called adenomyosis. Adenomyosis can cause severe pain in the lower mid abdomen and pelvis. There are only two ways to effectively treat this condition. One is to perform a hysterectomy (removal of the uterus). The other is to interrupt the nerves going to the uterus (presacral neurectomy). If the pain is located on one side or the other of the lower abdomen but not in the midline, it is not appropriate to treat this with presacral neurectomy. Laparoscopic presacral neurectomy should only be considered if other treatments such as non-steroidal anti-inflammatory medication such as ibuprofen or naproxen and oral contraceptive pills do not relieve the pain.
Until the late 1980’s, presacral neurectomy required a large abdominal incision , a so-called laparotomy. Techniques and equipment were developed to allow the procedure to be done at laparoscopy. Laparoscopic presacral neurectomy is performed under general anesthesia using a video laparoscope through a small incision, usually in the bellybutton. Several (usually three) small incisions are made above the pubic hairline for insertion of other instruments needed to perform the procedure.  Nerve tissue that goes to and from the uterus is interrupted in an area over the sacral promontory (where the lower spine and tail bone meet). This location is chosen because it is the best area to access the nerves to the uterus. Other surgical procedures, if appropriate, may be performed at the same time as the presacral neurectomy.
Because of the area (the sacral promontory) where the surgery is performed, very careful surgical technique is necessary to avoid unnecessary complications. The area is surrounded by major blood vessels, the ureters that connect the kidneys to the bladder, and intestine. Laparoscopic presacral neurectomy is an advanced laparoscopic procedure only performed by a few physicians.
LUNA or laparoscopic uterosacral nerve ablation has also been used to treat this midline pain. But many studies show that the long-term pain relief is less that 50%. The presacral neurectomy usually results in a 90% relief of pain.

Problems as a result of laparoscopic presacral neurectomy are uncommon but can occur. These may include urinary retention (inability to urinate) and constipation. In most instances normal urinary function returns in less than a week and the constipation resolves within two months.