Robotic Presacral Neurectomy

Robotic Surgery for Endometriosis and Chronic Pelvic Pain

Robotic presacral neurectomy is performed in order to reduce overall pelvic pain when endometriosis—the abnormal growth of endometrial cells outside the uterus—is present. This procedure, which involves removal of the presacral plexus (the group of nerve fibers responsible for transmitting pain signals from the uterus to the brain), can also be helpful in the absence of endometriosis for managing pelvic pain when a woman has painful periods (dysmenorrhea).

Because it combines the trauma-sparing advantages of a minimally-invasive procedure with superior surgical capabilities, robot-assisted presacral neurectomy is now increasingly being used to treat these conditions. The da Vinci Si's magnified 3-D, high-definition image and hydraulic-powered, computer-guided instruments provide improved visualization of the operating site and increased precision, enabling the surgeon to more accurately remove abnormal tissue and, in many cases, work faster.

How Robotic Presacral Neurectomy is Performed

In robotic presacral neurectomy, which is usually performed along with radical resection of endometriosis, four standard ports for the robot's camera and instrument arms are placed in the patient's abdomen using quarter-inch incisions. A small incision is then made in the lining of the abdomen below the aorta, and the nerves that are part of the lumbar sympathetic plexus are identified and removed through this incision.

Advantages of Robotic Presacral Neurectomy

Less post-operative pain. As with laparoscopic surgery, robotic presacral neurectomy is performed through smaller incisions than open surgery, leading to less post-surgical pain. There is also less manipulation of incision sites by the surgeon when using the da Vinci Si, which may be another reason for decreased post-operative pain in the robotic procedure compared with laparoscopic surgery.
Faster recovery. Most patients are able to resume normal activities within 2 weeks following robotic presacral neurectomy, compared to 6 weeks for open surgery.
The excellent precision and visualization offered by the da Vinci Si enhances the surgeon's ability to visualize critical anatomic structures in a very small area.

Robotic Presacral Neurectomy at NYULMC

The robotic gynecologic surgeons at NYU Langone's Robotic Surgery Center are among the most highly skilled in the New York City area. Our surgical program for the management of benign gynecologic conditions is spearheaded by Dr. Kenneth Levey, who specializes in the surgical treatment of endometriosis, uterine fibroids, abnormal uterine bleeding, and chronic pelvic pain. Dr. Levey is one of New York's most experienced surgeons at both robotic and laparoscopic minimally-invasive gynecological procedures, and has used the da Vinci Si surgical system extensively to perform robotic presacral neurectomies.

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