Surgical Interruption of Pelvic Nerve Pathways for the Treatment of Chronic Pelvic Pain
DESCRIPTION
Uterine nerve ablation and presacral neurectomy are two laparoscopic surgical procedures that have been investigated as techniques to interrupt the majority of the cervical sensory nerve fibers that transmit pain signals from the uterus.
Uterine nerve ablation involves the transaction of the uterosacral ligaments at their insertion into the cervix, while presacral neurectomy involves the removal of the presacral nerves lying within the interiliac triangle. Presacral neurectomy interrupts a greater number of nerve pathways compared to laparoscopic uterine nerve ablation (LUNA), and is technically more demanding. Both LUNA and presacral neurectomy can be performed as adjuncts to conservative surgical therapy.
POLICY
Uterine nerve ablation and presacral neurectomy for the treatment of chronic pelvic pain are considered investigational.
IMPORTANT REMINDER
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ADDITIONAL INFORMATION
There is inadequate published data to permit scientific conclusions regarding uterine nerve ablation or presacral neurectomy. While there are trials that report positive results, the net health benefits considering the complication risks remains unclear.
SOURCES
BlueCross BlueShield Association. Medical Policy Reference Manual. (3:2010). Surgical interruption of pelvic nerve pathways for primary and secondary dysmenorrhea (4.01.17). Retrieved January 6, 2011 from BlueWeb.
Daniels, J., Gray, R., Hills, R., Latthe, P., Buckley, L., Gupta, J., et al. (2009) Laparoscopic uterosacralnerve ablation for alleviating chronic pelvic pain, JAMA, 302 (9), 955-961. (Level 1 Evidence - Independent)
National Guideline Clearinghouse. American College of Obstetricians and Gynecologists (2008, Reaffirmed). Chronic pelvic pain. ACOG Practice Bulletin No. 51. Retrieved February 7, 2011 from http://www.guideline.gov/.
National Institute for Health and Clinical Excellence. (2007, October). Laparoscopic uterine nerve ablation (LUNA) for chronic pelvic pain. Retrieved February 8, 2011 from http://guidance.nice.org.uk/IPG234/Guidance/pdf/English.
Winifred S. Hayes. Medical Technology Directory. (2005, May; last update search September 30, 2009). Surgical interruption of pelvic nerve pathways for the treatment of chronic pelvic pain. Retrieved February 11, 2011 from www.hayesinc.com/subscribers. (22 articles and/or guidelines reviewed)
ORIGINAL EFFECTIVE DATE: 2/1/2002
MOST RECENT REVIEW DATE: 3/10/2011
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