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.
The key to alleviating pelvic pain is to make all appropriate diagnoses and effectively treat each one.
When endometriosis involves the uterosacral ligaments, all of the disease 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 visit our FAQ. As always, we want to help however we might be able, so please do not hesitate to contact us today!