title: Addition of laparoscopic uterine nerve ablation to laparoscopic bipolar coagulation of uterine vessels for women with uterine myomas and dysmenorrhea. Deriving dichotomous outcome measures from continuous data in randomised controlled trials of analgesics: verification from independent data Prospective, randomized, double-blind, controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal, mild, and moderate endometriosis. Surgical treatment of primary dysmenorrhea with laparoscopic uterine nerve ablation. Follow-up report on a randomized controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal to moderate endometriosis. Presacral neurectomy for the treatment of pelvic pain associated with endometriosis: a controlled study. Comparison of laparoscopic presacral neurectomy and laparoscopic uterine nerve ablation for primary dysmenorrhea. The Efficacy of Presacral Neurectomy for the Relief of Midline Dysmenorrhea
abstract: STUDY 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 ) .  DESIGN Prospect i ve , r and omized , longitudinal study ( Canadian Task Force classification II-1 ) . SETTING Private practice , university-affiliated hospital . PATIENTS Eighty-five women with uterine leiomyomas and associated dysmenorrhea . INTERVENTION Laparoscopic bipolar coagulation of uterine vessels with or without LUNA . MEASUREMENTS AND MAIN 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 ) . CONCLUSION Our results suggest that LUNA may decrease postoperative ischemic pain and improve dysmenorrhea associated with uterine myomas treated by LBCUV Abstract A previously established relationship for deriving dichotomous from continuous information in r and omised controlled trials ( RCTs ) of analgesics has been tested using an independent data set . Individual patient information from 18 RCTs of parallel‐group design in acute postoperative pain ( after abdominal , gynaecological and oral surgery ) was used to calculate the percentage of the maximum possible pain relief score  ( % maxTOTPAR ) and the proportion of patients with > 50%maxTOTPAR for the different treatments . The relationship between the measures was investigated in 85 treatments with over 3400 patients . In 80 of 85 treatments ( 94 % ) agreement between calculated and actual number of patients with > 50%maxTOTPAR was within four patients per treatment and in 72 ( 85 % ) was within three ( average of 40 patients per treatment , range 21–58 patients ) . Summing the positive and negative differences between actual and calculated numbers of patients with > 50%maxTOTPAR gave an average difference of 0.30 patients per treatment arm . Reports of RCTs of analgesics frequently describe results of studies in the form of mean derived indices , rather than using discontinuous events , such as number or proportion of patients with 50 % pain relief . Because mean data inadequately describe information with a non‐normal distribution , combining mean data in systematic review s may compromise the results . Showing that dichotomous data can reliably be derived from mean data in acute pain studies enables data published as means to be used for quantitative systematic review s which require data in dichotomous form OBJECTIVE To assess the efficacy of laser laparoscopic surgery in the treatment of  pain associated with minimal , mild , and moderate endometriosis . DESIGN A prospect i ve , r and omized , double-blind , and controlled clinical study . SETTING Royal Surrey County Hospital , Guildford , United Kingdom , a referral center for the laser laparoscopic treatment of endometriosis . PATIENTS Sixty-three patients with pain ( dysmenorrhoea , pelvic pain , or dyspareunia ) and minimal to moderate endometriosis . INTERVENTIONS The patients were r and omized at the time of laparoscopy to laser ablation of endometriotic deposits and laparoscopic uterine nerve ablation or expectant management .  Pain symptoms were recorded subjectively and by visual analogue scale . The women were unaware of the treatment allocated as was the nurse who assessed them at 3 and 6 months after surgery . MAIN OUTCOME MEASURE Improvement or resolution of pain symptoms assessed subjectively and by visual analogue score . RESULTS Laser laparoscopy results in statistically significant pain relief compared with expectant management at 6 months after surgery . Sixty-two and a half percent of the lasered patients reported improvement or resolution of symptoms compared with 22.6 % in the expectant group . Results were poorest for minimal disease and , if patients with mild and moderate disease only are included , 73.7 % of patients achieved pain relief . There were no operative or laser complications . CONCLUSIONS Laser laparoscopy is a safe , simple , and effective treatment in alleviating pain symptoms in women with stages I , II , and III endometriosis With approximately 25 % of dysmenorrheic patients reporting no improvement with nonsteroidal anti-inflammatory drugs , a study was devised to evaluate the effectiveness of a laparoscopic technique for the interruption of the uterosacral nerves . In a double-blind study of 21 patients with primary dysmenorrhea , 81 % ( 9 of 11 ) reported significant relief from menstrual pain after the surgery . Performed as an outpatient procedure , laparoscopic uterine nerve ablation may alleviate dysmenorrheic complaints when other modalities have failed . Half the treated women reported continued relief of menstrual pain at 12 months . These results suggest that uterosacral nerve interruption may prove an effective alternative treatment for this menstrual disorder OBJECTIVE To assess the longer term efficacy of laparoscopic laser surgery in the treatment of painful pelvic endometriosis and to observe the natural history of the disease at second-look laparoscopy in a control group . DESIGN One-year follow-up of a prospect i ve , r and omized , double-blind controlled trial . SETTING A referral center for the laparoscopic laser treatment of endometriosis . PATIENT(S ) Sixty-three patients with pelvic pain and minimal to moderate endometriosis . INTERVENTION(S ) After the 6-month follow-up visit , the r and omization code was broken , and follow-up was continued to 1 year . Symptomatic patients were offered second-look laser laparoscopy . MAIN OUTCOME MEASURE(S ) Continued symptom relief at 1 year after treatment and findings at second-look laparoscopy in symptomatic controls . RESULT ( S ) Symptom relief continued at 1 year in 90 % of those who initially responded . All symptomatic controls had a second-look procedure , with 7 ( 29 % ) showing disease progression , 7 ( 29 % ) showing disease regression , and 10 ( 42 % ) having static disease . CONCLUSION ( S ) The benefits of laser laparoscopy for painful pelvic endometriosis are continued in the majority of patients at 1 year . Untreated painful endometriosis will progress or remain static in the majority of patients but will spontaneously improve in others OBJECTIVE Our objective was to evaluate the efficacy of presacral neurectomy combined with conservative surgery for the treatment of  pelvic pain associated with endometriosis . STUDY DESIGN In a r and omized , controlled study performed in a tertiary institution 71 patients with moderate or severe endometriosis and midline dysmenorrhea were r and omly assigned to conservative surgery alone ( n = 36 ) or conservative surgery and presacral neurectomy ( n = 35 ) . Main outcome measures were relief of dysmenorrhea , pelvic pain , and deep dyspareunia after surgery according to a multidimensional and an analog pain scale . RESULTS Presacral neurectomy markedly reduced the midline component of menstrual pain , but no statistically significant differences were observed between the two groups in the frequency and severity of dysmenorrhea , pelvic pain , and dyspareunia in the long-term follow-up . After presacral neurectomy , constipation developed or worsened in 13 patients and urinary urgency occurred in three and a painless first stage of labor in two . CONCLUSION Presacral neurectomy should be combined with conservative surgery for endometriosis only in selected cases OBJECTIVE To compare laparoscopic presacral neurectomy and laparoscopic uterine nerve ablation for  primary dysmenorrhea .  STUDY DESIGN Sixty-eight patients with primary dysmenorrhea and a poor response to medical treatment were r and omized into two groups . One group ( 33 patients ) had laparoscopic presacral neurectomy ( LPSN ) and the other group ( 35 patients ) , laparoscopic uterine nerve ablation ( LUNA ) . RESULTS There were no complications , and all the patients left the hospital within 24 hours after surgery . The efficacy of both surgical methods was almost equal ( 87.9 % vs. 82.9 % ) at the 3-month postoperative follow-up visit , but the efficacy of LPSN was significantly better than that of LUNA ( 81.8 % vs 51.4 % ) at the 12-month visit . CONCLUSION LPSN is a valid option for treating primary dysmenorrhea The present study was undertaken to evaluate prospect ively the efficacy of presacral neurectomy for the treatment of midline dysmenorrhea .  All patients had moderate to severe dysmenorrhea and stage III-IV endometriosis . Of the patients undergoing presacral neurectomy ( N=17 ) , only two had a recurrence of pain . The remainder of the patients undergoing presacral neurectomy  remain pain-free at 42 months of follow-up . Of the patients undergoing resection of endometriosis but not presacral neurectomy ( N=9 ) , none received relief of midline pain . Relief of lateral pain , back pain , and dyspareunia was variable in both groups . Our findings corroborate previous retrospective studies showing that presacral neurectomy is highly effective in the treatment of dysmenorrhea . We speculate that the most common reasons for failure of presacral neurectomy are inappropriate selection of patients and incomplete resection of the presacral nerve
target: MAIN RESULTS For the treatment of primary dysmenorrhoea there is some evidence of the effectiveness of uterine nerve ablation ( UNA ) when compared to a control of no treatment .
  The comparison between UNA with presacral neurectomy ( PSN ) for primary dysmenorrhoea showed no significant difference in pain relief in the short term , however long term PSN was shown to be significantly more effective .
  The treatment of UNA combined with surgical treatment of endometrial implants versus surgical treatment of endometriosis alone showed that the addition of UNA did not aid pain relief .
  For PSN combined with endometriosis treatment versus endometriosis treatment alone there was also no overall difference in pain relief , although the data suggests a significant difference in relief of midline abdominal pain .
  Adverse events were significantly more common for presacral neurectomy , however the majority were complications such as constipation , which may spontaneously improve .
  REVIEW ER 'S CONCLUSIONS There is insufficient evidence to recommend the use of nerve interruption in the management of dysmenorrhoea , regardless of cause .
background: BACKGROUND Dysmenorrhoea is the occurrence of painful menstrual cramps of uterine origin and is a very common gynaecological complaint .
  Medical therapy for dysmenorrhoea includes oral contraceptive pills ( OCP ) and nonsteroidal anti-inflammatory drugs ( NSAIDS ) which both act by suppressing prostagl and in levels .
  While these treatments are very successful there is still a 20 - 25 % failure rate and surgery has been an option for cases of dysmenorrhoea that fail to respond to medical therapy .
  Uterine nerve ablation ( UNA ) and presacral neurectomy ( PSN ) are two surgical treatments that have become increasingly utilised in recent years .
  These procedures both interrupt the majority of the cervical sensory nerve fibres , thus diminishing uterine pain .
  Uncontrolled studies have supported the use of these procedures for primary dysmenorrhoea however both operations only partially interrupt some of the cervical sensory nerve fibres in the pelvic area ; therefore dysmenorrhoea associated with additional pelvic pathology may not always benefit from this type of surgery .
  OBJECTIVES To assess the effectiveness of surgical interruption of pelvic nerve pathways as treatment for primary and secondary dysmenorrhoea , and to determine the most effective surgical treatment .