Laparoscopic uterosacral nerve ablation in chronic pelvic pain: an overview

Abstract

Listen

Translate article

ObjectiveTo assess the efficacy of laparoscopic uterine nerve ablation (LUNA) in the treatment of chronic pelvic pain, by means of a systematic overview of the published literature.DesignRelevant papers were identified through electronic scanning of MEDLINE (1966 1997), EMBASE (1980m 1997), the Science Citation Index and the Cochrane Library, and manual searching of the bibliography of known primary and review articles. Study selection, study quality assessment and data abstraction were performed independently in duplicate. For controlled studies data were used to generate odds ratios (OR) and their confidence intervals (CI).SubjectsThese were 555 women included in 11 case series and 250 women included in two controlled observational studies and three randomized trials.Main outcome measurePain relief, measured in general terms or assessed using visual analogue or numeric pain scales.ResultsIn the case of pelvic pain with no visible pathological findings at laparoscopy, randomized studies showed that LUNA had a trend towards better pain relief compared with no surgical intervention (OR 9.4, 95% CI 0.7 to 472; P = 0.9) but its effect was inferior to presacral neurectomy (OR 0.24, 95% CI 0.07 to 0.8; P = 0.01). Where there was endometriosis, controlled non‐randomized studies showed that with ablative treatment of endometriosis, the outcomes were better with than without LUNA (OR 36.7, 95% CI 3.9 to 1625; P = 0.001); however, presacral neurectomy did not show better results than LUNA (OR 0.30, 95% CI 0.03 to 1.76; P = 0.1). One randomized controlled study in patients with endometriosis showed that LUNA plus ablative treatment was better than no intervention (OR 5.7, 95% CI 1.6 to 20.3; P = 0.003), an effect that was not apparent in the subgroup with minimal endometriosis (P = 0.24).ConclusionOn theoretical grounds, LUNA has the promise of an efficacious intervention in alleviating pelvic pain. However, the pitfalls in the published research that we have identified and evaluated make it impossible for us to conclude that this intervention is universally effective. At best there is a trend indicating effectiveness in relieving primary dysmenorrhoea and mild to moderate endometriosis. For the majority of women with chronic pelvic pain, there is not sufficient evidence to guide therapeutic decision making with regard to laparoscopic uterine nerve ablation.