(Updated Summer
2008)
What is a
“LUNA”?
“LUNA” is the acronym for “Laparoscopic
Uterosacral Nerve Ablation.” This differs from PSN, or “Presacral
Neurectomy.” PSN is similar to LUNA only in that it is a
technique for destroying the ability of certain nerves to function
normally. PSN carries with it a bit more risk than LUNA. It involves
transecting the multiple cobweb-like presacral nerves after they
cross the pelvic brim just below the bifurcation of the large blood
vessels (vena cava) and medial to the ureter. For the purposes of
this article, we are addressing only the LUNA procedure.
What does it do?
The
uterosacral nerves run in the uterosacral ligament. They are
parasympathetic nerves, not usually visible to the naked eye. LUNA
is a surgical procedure designed to destroy these nerve pathways,
and is usually done by coagulation, Harmonic Scalpel ablation, laser
ablation, or excision.
When is it done?
Some pelvic surgeons, in an attempt
to reduce pelvic pain, may perform LUNA. Although side effects and
complications are uncommon, there is minimal support for this
procedure as an effective way of controlling pelvic pain.
It may still have some benefit for
patients who have no recognizable disease and whose pain is central
(i.e., in the midline of the pelvis), but there are no credible
studies to support this conclusion.
When do we do
LUNA here at the CEC?
The key to alleviating pelvic pain
is to make all appropriate diagnoses (please see
http://centerforendo.com/articles/painafterexcision.htm
for further details), and to treat each one.
Although I have no proof that it
will be beneficial, I would certainly offer LUNA to a patient with
suspected Adenomyosis (please see
http://www.centerforendo.com/articles/adenomyosis.htm
to learn more) who is attempting to control her pain while
still preserving her uterus.
When Endometriosis involves the
uterosacral ligaments, all of the Endo must be completely excised.
The result of the excision of the disease in the ligament is a LUNA
procedure that results from treating the Endometriosis, but is not
the primary intended procedure. Some of our patients will see this
procedure listed on their operative report, as it further describes
the technical detail of what was done as part of their complete
excision by us.
For more information on excision
and how the CEC might be able to help you, please refer to our
extensive database of articles at
http://www.centerforendo.com/cecarticles.htm.
As always, we want to help however
we might be able, so please do not hesitate to write or call us
today!