Uterosacral nerve ablation

Deep dyspareunia, often described as pain resulting from pelvic thrusting during sexual intercourse, is relatively common and has many causes. To date, feasible surgical interventions for deep dyspareunia are very rare. The two procedures which have been mentioned in the literature for the treatment of deep dyspareunia were laparoscopic uterosacral ligament ablation (LUNA) and uterine ventrosuspension. We report the case of a young female patient, aged 32, gravida 3, parity 2, presenting with deep dyspareunia and primary dysmenorrhea for 4 years...

To explore gynaecologists' 'prior' beliefs on effectiveness of laparoscopic uterosacral nerve ablation (LUNA), a structured survey was used to gather information on the distribution of their prior beliefs regarding the effects of LUNA on pelvic pain, both numerically [on a 10-point visual analogue scale] and by responses to a questionnaire. None of the 25 gynaecologists responding to the questionnaire stated that LUNA would increase pain, while two of the 25 gave numerical answers suggesting they believed that the intervention would worsen the pain...

To examine the variation in current indications and surgical techniques for performing laparoscopic uterosacral nerve ablation (LUNA) in Europe, all consultants on the databases of the UK Royal College of Obstetricians and Gynaecologists (1569) and the European Society of Gynaecological Endoscopy (301) were surveyed. The questionnaire was returned by 719 (38% of 1870) of the gynaecologists contacted and 173 (24%) performed LUNA. Indications for LUNA, which included chronic pelvic pain (68%), dysmenorrhoea (66%), dyspareunia (39%) and endometriosis (60%), were similar across the United Kingdom and the rest of Europe...

BACKGROUND: Chronic pelvic pain is a common condition with a major impact on health-related quality of life, work productivity and health care utilisation. The cause of the pain is not always obvious as no pathology is seen in 40-60% of the cases. In the absence of pathology there is no established treatment. The Lee-Frankenhauser sensory nerve plexuses and parasympathetic ganglia in the uterosacral ligaments carry pain from the uterus, cervix and other pelvic structures. Interruption of these nerve trunks by laparoscopic uterosacral nerve ablation (LUNA) may alleviate pain...

There have been few appropriately conducted trials to evaluate the effectiveness of laser destruction of endometriosis in relieving pain symptoms, yet the techniques are increasingly being used. Laser destruction has been shown to be more effective than the placebo effect of laparoscopy alone in one trial, at least at 6-month follow-up. Longer-term studies suggest increasing recurrence of symptoms with time [23% at 12 months in one study, and 44% by a mean of 19.7 months (5-60) follow-up]. These recurrence rates are similar to those seen following 6 months medical treatment...

Chronic pelvic pain is common in women of reproductive age and accounts for more than 40% of all laparoscopic procedures. In up to 40% of these patients laparoscopic findings are negative. As a result, many gynecologists frequently excise portions of the uterosacral ligaments and biopsy inconspicuous pelvic lesions in an effort to perform uterosacral nerve ablation and also to identify subclinical endometriosis. During diagnostic laparoscopy for chronic intermittent pelvic and abdominal pain, a 37-year-old woman was noted to have an incidental, 5-mm, pink-white nodule in the right uterosacral ligament...

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...

OBJECTIVE: To develop recommendations for the medical and surgical care of women who present with chronic pelvic pain (CPP) and are likely to have endometriosis as the underlying cause. DESIGN: An expert panel comprised of practicing gynecologists from throughout the United States and experts in consensus guideline development was convened. After completion of a structured literature search and creation of draft algorithms by an executive committee, the expert panel of >50 practicing gynecologists met for a 2-day consensus conference during which the clinical recommendations and algorithms were reviewed, refined, and then ratified by unanimous or near-unanimous votes...

The source of chronic pelvic pain may be reproductive organ, urological, musculoskeletal-neurological, gastrointestinal, or myofascial. A psychological component almost always is a factor, whether as an antecedent event or presenting as depression as result of the pain. Surgical interventions for chronic pelvic pain include: 1) resection or vaporization of vulvar/vestibular tissue for human papillion virus (HPV) induced or chronic vulvodynia/vestibulitis; 2) cervical dilation for cervix stenosis; 3) hysteroscopic resection for intracavitary or submucous myomas or intracavitary polyps; 4) myomectomy or myolysis for symptomatic intramural, subserosal or pedunculated myomas; 5) adhesiolysis for peritubular and periovarian adhesions, and enterolysis for bowel adhesions, adhesiolysis for all thick adhesions in areas of pain as well as thin ahesions affecting critical structures such as ovaries and tubes; 6) salpingectomy or neosalpingostomy for symptomatic hydrosalpinx; 7) ovarian treatment for symptomatic ovarian pain; 8) uterosacral nerve vaporization for dysmenorrhea; 9) presacral neurectomy for disabling central pain primarily of uterine but also of bladder origin; 10) resection of endometriosis from all surfaces including removal from bladder and bowel as well as from the rectovaginal septal space...

STUDY OBJECTIVE: To evaluate the safety of diagnostic and operative microlaparoscopy performed in the office under local anesthesia in the diagnosis and treatment of chronic pelvic pain. DESIGN: Prospective study (Canadian Task Force classification II-2). SETTING: Office-based, free-standing private obstetrics and gynecology practice. PATIENTS: Twenty women with chronic pelvic pain. INTERVENTION: Diagnostic and operative microlaparoscopy performed under local anesthesia with conscious sedation...

From October 1992 to February 1996, 1506 gynecologic surgeries were performed in our hospital. Of these, 270 (17.9%) were done by laparoscopy: 204 (75.5%) operative and 66 (24.5%) diagnostic. The procedures were 59 (28.9%) hysterectomies, 15 (25.4%) of them radical hysterectomies, 6 laparoscopic-assisted stagings for endometrial cancer, and 38 laparoscopic-assisted vaginal hysterectomies. Fifty-eight (28.4%) surgeries were performed for adnexal masses and 16 (7.8%) for ectopic pregnancies. We also did 7 (3...

Fifty-five patients with endometriosis in whom argon beam coagulation was used through the laparoscope for coagulation of endometrial lesions, lysis of pelvic adhesions, uterosacral nerve ablation (LUNA) and presacral neurectomy (PSN) were evaluated retrospectively. Thirty patients (54%) had pelvic pain, and 25 patients (46%) presented with pelvic pain and/or infertility. Postoperatively, 29 (72.5%) women showed improvement of pain, 6 (15%) had no change of pain, and in 5 (12.5%) the pain became worse. Seven patients were able to conceive after longstanding infertility, for an early crude pregnancy rate of 28%...

Evaluating patients with chronic pelvic pain is complex. A detailed medical history should be ideally supplemented by psychologic evaluation and assessment of the woman's social background. At the time of physical examination, the location and intensity of the pain should be mapped. Assessment of pain relief with the administration of a local anesthetic to trigger points or selected nerves may be useful in predicting the potential efficacy of surgical interventions such as uterosacral nerve ablation. Appropriate tests include pelvic ultrasound and magnetic resonance imaging...

Laparoscopic surgery as an alternative to traditional laparotomies has become an important modality in the management of gynecologic diseases; however, it is not without potential risks. Case reports describe numerous complications, including ureteral injuries, persistent ectopic pregnancies, hospital readmissions, unintended laparotomies to manage bowel or urinary tract injury, and hemorrhage. We retrospectively analyzed 195 women who underwent laparoscopic procedures to determine the frequency and severity of operative complications...

BACKGROUND: Laparoscopic uterine nerve ablation (LUNA) has become a common alternative therapy for refractory dysmenorrhea. Few long-term complications have been reported. CASES: Severe uterine prolapse was diagnosed in three young female soldiers during or after the rigors of airborne training. All three had previously undergone LUNA procedures. No other risk factors for uterine prolapse could be identified in these cases. CONCLUSION: The etiology of uterine prolapse is complex, and although no conclusions as to cause and effect can be made, these cases suggest that LUNA should be performed with caution on women whose occupation or life-style is associated with heavy physical labor or exercises producing marked increases in intraabdominal pressure...

With approximately 25% of dysmenorrheic patients reporting no improvement with nonsteroidal anti-inflammatory drugs, a study was devised to evaluate the effectiveness of a laparoscopic technique for the interruption of the uterosacral nerves. In a double-blind study of 21 patients with primary dysmenorrhea, 81% (9 of 11) reported significant relief from menstrual pain after the surgery. Performed as an outpatient procedure, laparoscopic uterine nerve ablation may alleviate dysmenorrheic complaints when other modalities have failed...

Since the 1960s, medical therapy utilizing nonsteroidal antiinflammatory drugs and oral contraceptives with the addition of danazol and gonadotropin releasing hormone have become the treatment of choice for chronic pelvic pain and dysmenorrhea. The surgical approach to this problem, incorporating interruption of the superior hypogastric nerve plexus (presacral neurectomy), therefore, has become less popular. Investigations, however, have demonstrated that 20-25% of patients treated medically for this problem fail to show an improvement...

Two cases of severe uterine prolapse are reported following laser uterosacral nerve ablation (LUNA). Both patients had a history of vaginal childbirth and subsequent development of secondary infertility and severe dysmenorrhea. It is suggested that this procedure be performed with caution on vaginally parous patients, and that it be reserved for use in patients who have adequate uterine support. Future studies are needed to determine the long-term incidence of uterine procidentia following this procedure.