Addition of laparoscopic uterine nerve ablation to laparoscopic bipolar coagulation of uterine vessels for women with uterine myomas and dysmenorrhea.
OBJECTIVE
To assess the effectiveness of laparoscopic uterine nerve ablation (LUNA) in women with dysmenorrhea caused by uterine myomas treated by laparoscopic bipolar coagulation of uterine vessels (LBCUV).


METHODS
Prospective, randomized, longitudinal study (Canadian Task Force classification II-1).


METHODS
Private practice, university-affiliated hospital.


METHODS
Eighty-five women with uterine leiomyomas and associated dysmenorrhea.


METHODS
Laparoscopic bipolar coagulation of uterine vessels with or without LUNA.


RESULTS
Of 85 patients who entered the study, 41 were assigned to undergo LBCUV-LUNA (group A), which was successful in 40 (97.6%). In 44 women assigned to have LBCUV only (group B), 43 (97.7%) underwent successful surgery. Eighty women completed 1-, 3-, and 6-month follow-up (38 group A, 42 group B). The groups did not differ significantly in age, history of abdominopelvic surgery, intraperitoneal adhesions, endometriosis, concomitant surgery, and operating time. Seven (18.4%) of 38 women in group A and 12 (28.6%) of 42 in group B experienced lower abdominal pain postoperatively. Acceptable pain was defined as a score of zero or 1: 31 and 30 women in groups A and B reported scores of zero; 3 and 2 reported scores of 1; 4 and 8 reported scores of 2; zero and 2 reported scores of 3; and no patients reported scores of 4. The frequency and severity of postoperative pain were less in group A than in group B (both p <0.05). The efficacy of both methods was almost equal in shrinking the uterus and dominant myoma, and in improving menorrhagia and bulk-related symptoms. Dysmenorrhea improvement was 84.2% and 61.9% in groups A and B at 3 months and 92.1% and 73.8% at 6 months, respectively. This was more significant in group A than in group B (p <0.05).


CONCLUSIONS
Our results suggest that LUNA may decrease postoperative ischemic pain and improve dysmenorrhea associated with uterine myomas treated by LBCUV.
Yen
Y K
YK
Department of Obstetrics and Gynecology, VGH-Taipei, National Yang Ming University, Taipei, Taiwan.
Liu
W M
WM
Yuan
C C
CC
Ng
H T
HT
D000293:Adolescent; D000328:Adult; D017115:Catheter Ablation / Q000379:methods*; D003131:Combined Modality Therapy; D004412:Dysmenorrhea / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D004564:Electrocoagulation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007889:Leiomyoma / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008137:Longitudinal Studies; D008875:Middle Aged; D011446:Prospective Studies; D012016:Reference Values; D016896:Treatment Outcome; D014463:Ultrasonography; D014594:Uterine Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D014599:Uterus / Q000098:blood supply / Q000294:innervation