The Role of Laparoscopic Uterine Nerve Ablation(LUNA) and Presacral Neurectomy (PSN) of PelvicPain Management

Ashon Sa'adi
In: Journal of laparoscopic surgery · 2008 · vol. 1(3) , pp. 39–45 · W1603693932
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Abstract

Background: The chronic pelvic pain as non-cyclical pain is seriousenough to cause disability or lead to medical care. While these treatmentsare very successful there is still a 20 to 25% failure rate and surgeryhas been an option for such cases. Effectiveness of laparoscopicuterosacral nerve ablation (LUNA) and presacral neurectomy (PSN)can be useful for alleviating chronic pelvic pain.Objectives: To assess the effectiveness of surgical interruption ofpelvic nerve pathways in primary and secondary dysmenorrheal inthe chonic pelvic pain.Data sources: Various watchfulness sources related to surgically chronicpelvic pain treatment from various causes and journals, also involvethe Cochrane Menstrual Disorders and Subfertility Group TrialsRegister (9 June 2004), CENTRAL (The Cochrane Library, Issue 2,2004), MEDLINE (1966 to Nov. 2003), EMBASE (1980 to Nov.2003), CINAHL (1982 to Oct. 2003), MetaRegister of ControlledTrials, the citation lists of review articles and included trials.Methods: Review and analyzed of prospective study of laparoscopypresacral neurectomy / PSN or laparoscopy uterosacral nerve ablation/ LUNA (both open and laparoscopic procedures) for the treatment ofpelvic pain ( primary and secondary dysmenorrheal). The main outcomemeasures were pain relief and adverse effects.Results: We have got 13 sources analysis extracted data oncharacteristics of the study quality and the population, intervention,and outcome independently. Nine randomized controlled trials wereincluded in the systematic review. There were two trials with openpresacral neurectomy; all other trials used laparoscopic techniques.For the treatment of primary dysmenorrhea, laparoscopic uterosacralnerve ablation at 12 months was better when compared to a control orno treatment. The comparison of laparoscopic uterosacral nerve ablationwith presacral neurectomy for primary dysmenorrhea showed that at12 months follow-up, presacral neurectomy was more effective. Insecondary dysmenorrhea, along with laparoscopic surgical treatmentof endometriosis, the addition of laparoscopic uterosacral nerve ablationdid not improve the pain relief, while comparing to presacralneurectomy. Side effects were more common for presacral neurectomythan procedures laparoscopy uterine nerve ablation.The Role of Laparoscopic Uterine Nerve Ablation(LUNA) and Presacral Neurectomy (PSN) of PelvicPain ManagementAshon Sa'adiGynecological Specialist and Laparoscopic Surgeon, Department of Obstetrics and Gynecology, Dr Soetomo Hospital ofSurabaya, IndonesiaConclusion: Currently, we have showed that LUNA and PSN can bean option in primary or secondary menstrual pain withoutendometriosis; LUNA has not been shown to reduce dysmenorrheaand, therefore, should not be advocated as a mainstream treatmentexcept who have persistent dysmenorrhea.

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endometriosischronic_pelvic_paindysmenorrhea

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