The Efficacy of Laparoscopic Uterosacral Nerve Ablation (LUNA) in the Treatment of Central Chronic Pelvic Pain

Objective: To determine the effectiveness of laparoscopic uteroscaral nerve ablation (LUNA) for treatment of central chronic pelvic pain in women without visible pelvic pathology.Design: A prospective observational study.Methods: Patients with central chronic pelvic pain (dysmenorrhoea, dyspareunia, and pelvic pain not associated with sexual intercourse or menstruation) with no pelvic pathology underwent LUNA procedure. Main outcomes were pain intensity and Health-related quality of life (HRQoL) at 3, 6 and 12 months post operatively. Change in pain intensity was assessed by a decrease in visual analogue score (VAS) to ≤3 and additionally by difference in mean visual analogue score. HRQoL was measured by the Short From Health Survey (SF-36) questionnaire.Results: Of the 17 participants available for statistical analysis 14, 13 and 13 showed improvement in pain intensity (VAS ≤3) at 3, 6 and 12 months post operatively, mean changes in VAS from preoperative score showed large effect size 0.8 (Means ± SD were 3.17±1.55, 3.35±1.61 and 3.41±1.69 at 3, 6 and 12 months post-operatively vs 7.64±1.11 preoperatively). Also significant improvements were observed in all SF-36 subscale scores (p 0.05) with moderate subscale effect sizes 0.5.Conclusion: Laparoscopic uteroscaral nerve ablation can be associated with improvements in pain intensity and quality of life in patients with central pelvic pain. However more studies with bigger number of patients are needed to support its efficacy and safety before the procedure becomes widely adopted for intractable chronic pelvic pain.