A prospective, randomized, double-blind controlled trial of laparoscopic uterine nerve ablation in the treatment of pelvic pain associated with endometriosis

Objective To determine the value of laparoscopic uterine nerve ablation (LUNA) as part of the laparoscopic laser treatment of painful endometriosis. Design A prospective randomized double-blind controlled trial. Setting A referral centre for the treatment of endometriosis. Subjects 51 women with pelvic pain and pelvic endometriosis. Intervention All patients underwent laparoscopic laser ablation of their endometriosis and were then randomly allocated to receive LUNA or no further treatment. Main outcome measures Dysmenorrhoea, dyspareunia and chronic nonmenstrual pelvic pain were assessed using visual analogue scales and structured questionnaires, preoperatively and at 3 and 6 months postoperatively. Results 24 patients were randomly allocated to receive laser vaporization alone, and 27 to receive a LUNA procedure in addition. The mean age of the patients involved was 28 years (range 20-41), with no differences between the groups for stage of endometriosis. Comparisons were made between the two treatment groups at 3 and 6 months. Significant differences in favour of the non-LUNA group were found at 3 months (P=0.003), and at 6 months (P=0.022) for dysmenorrhoea. A significant difference in favour of the non-LUNA group also occurred at 6 months for chronic non-menstrual pain (P=0.323). There were no significant differences recorded for dyspareunia. Bonferroni's adjustment was applied, and the only difference which remained significant was for dysmenorrhoea at 3 months (P=0.033) in favour of the non-LUNA group. The preoperative and 6-month pain scores for all the patients were combined. There was a significant improvement in the pain scores recorded at 6 months (P<0.0001). Conclusion Laparoscopic laser ablation of endometriosis is confirmed as an effective treatment, to which uterine nerve ablation adds no benefit.