Clinical question Is laparoscopic uterosacral nerve ablation (LUNA) effective for the treatment of women with chronic pelvic pain?

Bottom line LUNA is no more effective than sham surgery in alleviating chronic pelvic pain of uncertain etiology in adult women. (Level of evidence = 1b–)

Synopsis LUNA is a therapeutic procedure performed after a diagnostic laparoscopy in women with chronic pelvic pain of uncertain etiology

These investigators identified 487 women with chronic pelvic pain lasting longer than 6 months referred for diagnostic laparoscopy. After inspection of the pelvis, eligible patients found to have no other significant pathology (eg, endometriosis, adhesions, or serious pelvic lesions) randomly received (concealed allocation assignment) operative interruption of nerve trunks in the uterosacral ligaments or sham skin incisions corresponding to additional port sites used for the LUNA procedure. Individual patients masked to their treatment group assignment self-reported outcomes using a 10-cm visual analog pain scale (VAS). Complete follow-up occurred for 80% of patients at 12 months and for 72% at 5 years. Using intention-to-treat analysis, there were no significant differences reported between the LUNA group and the no- LUNA group for noncyclical pain, dysmenorrhea, dyspareunia, or healthrelated quality of life. The study was 80% powered to detect a predetermined clinically significant 1.2-cm difference on the VAS.

Daniels J, Gray R, Hills RK, et al; LUNA Trial Collaboration. Laproscopic uterosacral nerve ablation for alleviating chronic pelvic pain: a randomized controlled trial. JAMA. 2009;302(9):955-961.