title: Investigation of the localization of nerves in the uterosacral ligament: determination of the optimal site for uterosacral nerve ablation.
abstract: We select surgical treatment for cases for which severe dysmenorrhea persists following medical treatment. Many reports have described the use of neurectomies by cutting off pain conducting nerve pathways using laparoscopic surgery. Laparoscopic uterosacral nerve ablation (LUNA) has been associated with a high success rate for pain control, but there are few reports of anatomical studies in the uterosacral ligament. Using an immunohistochemical method, we examined the number and types of nerve fiber bundles in the uterosacral ligaments and its surrounding tissue in cadavers. The greatest number of nerve fiber bundles was found at a distance of 16.5-33 mm and at a depth of 3-15 mm distal to the site of attachment of the uterosacral ligament to the uterine cervix. Furthermore, there were many more sympathetic and parasympathetic nerve fiber bundles than sensory ones in the uterosacral ligament and its surrounding tissue. These results show the appropriate site of transection of uterosacral ligaments when performing LUNA.
authors.affiliation: Department of Gynecology and Obstetrics, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors.forename: Miho
authors.initials: M
authors.lastname: Fujii
authors.forename: Satoru
authors.initials: S
authors.lastname: Sagae
authors.forename: Toshio
authors.initials: T
authors.lastname: Sato
authors.forename: Mizuyo
authors.initials: M
authors.lastname: Tsugane
authors.forename: Gen
authors.initials: G
authors.lastname: Murakami
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Kudo
mesh_terms: D015740:Calcitonin Gene-Related Peptide / Q000032:analysis; D003714:Denervation; D004412:Dysmenorrhea / Q000601:surgery; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D010535:Laparoscopy; D008022:Ligaments / Q000294:innervation*; D009412:Nerve Fibers / Q000737:chemistry / Q000648:ultrastructure; D009478:Neuropeptide Y / Q000032:analysis; D010751:Phosphopyruvate Hydratase / Q000032:analysis; D012447:Sacrum; D014599:Uterus; D014660:Vasoactive Intestinal Peptide / Q000032:analysis
chemical_list: D009478:Neuropeptide Y; D014660:Vasoactive Intestinal Peptide; D010751:Phosphopyruvate Hydratase; D015740:Calcitonin Gene-Related Peptide