Laparoscopic uterine nerve ablation: A survey of gynaecological practice in the UK
Daniels J., Gray R., Khan KS., Gupta JK.
Objective. To determine the current use of and the indications for laparoscopic uterine nerve ablation (LUNA) in the UK, and to establish practitioners' views regarding the desirability of a controlled clinical trial to assess the efficacy of LUNA. Setting. Gynaecologists associated with the British Society of Gynecological Endoscopy. Design. A self-administered structured questionnaire was posted to 457 UK gynaecologists. Their surgical practice and willingness to participate in a randomized trial were surveyed. The postal questionnaire was returned by 249 (55% response rate). Results. The survey indicated that 113 (45%) of the responders performed LUNA. Of these, 86 (76%) carried out LUNA for chronic pelvic pain, 72 (64%) for endometriosis, and 16 (14%) for dyspaurenia/dysmenorrhoea. Diathermy was used as the surgical tool by 66 (59%) gynaecologists and laser was used by 57 (51%). Of the 113 currently using LUNA, 91 (81%) were willing to enter patients into a proposed clinical trial of LUNA. Conclusion. Current clinical practice regarding LUNA for pelvic pain is hung in equipoise. This means that the technique has been introduced without reliable evidence of efficacy but opinion regarding its use is not yet solidified. Hence, a rigorous randomized trial of LUNA's efficacy is urgently needed and is practicable.