Best Hospitals for Uterosacral Nerve Ablation (LUNA) in Mumbai, India

Chronic pelvic pain and primary or secondary dysmenorrhea affect an estimated 10–20% of women of reproductive age worldwide, significantly impairing quality of life, occupational productivity, and psychosocial wellbeing. The uterosacral ligaments serve as the primary conduit for sympathetic and parasympathetic afferent nociceptive fibers originating from the uterus and cervix, traveling via the Lee-Frankenhauser nerve plexus to the S2–S4 spinal segments. Disruption of this pathway is the physiological rationale behind Uterosacral Nerve Ablation (LUNA), which involves laparoscopic transection or laser vaporization of the medial portion of the uterosacral ligaments at their cervical insertion point.

• Women aged 18–50 with moderate-to-severe primary dysmenorrhea that has failed at least 3–6 months of first-line medical therapy (NSAIDs such as mefenamic acid or naproxen, and/or combined oral contraceptive pills or progestins)
• Patients with laparoscopically or histologically confirmed endometriosis (ASRM Stage I–IV) experiencing central, midline pelvic pain
• Women with adenomyosis-associated dysmenorrhea who wish to preserve uterine function (as an alternative or bridge to hysterectomy)
• Patients with chronic pelvic pain of central uterine origin unresponsive to GnRH agonists (e.g., leuprolide acetate) or levonorgestrel-releasing IUD therapy
• Candidates must have pain that is clearly midline and central in distribution; lateral pelvic pain is a contraindication and may indicate the need for Presacral Neurectomy instead

Required Diagnostic Workup Prior to LUNA:

• Transvaginal ultrasound (TVUS) to assess uterine morphology, endometrial thickness, and adnexal pathology
• MRI pelvis (with contrast if adenomyosis or deep infiltrating endometriosis is suspected) for precise anatomical mapping
• CA-125 serum levels (as a baseline marker for endometriosis activity, not diagnostic alone)
• Diagnostic laparoscopy with biopsy (gold standard for endometriosis staging per ASRM classification)
• Complete blood count (CBC), coagulation profile (PT/INR, aPTT), renal and hepatic function panels, and anaesthesia fitness assessment
• +2 more

LUNA is exclusively performed under general anaesthesia via a laparoscopic approach. The following techniques and platforms are available at GAF Healthcare partner institutions:

1. Standard Laparoscopic LUNA (Electrosurgical Transection): The most widely performed technique. A 10–12 mm umbilical port is established using a Veress needle or Hassan open entry technique, followed by two 5 mm accessory ports in the lower quadrants. The uterosacral ligaments are identified at their insertion into the posterior cervix, lateral to the midline. A 1–2 cm segment of each ligament is excised or coagulated using bipolar electrosurgery (e.g., LigaSure or Gyrus PK system) or monopolar scissors. The retroperitoneal course of both ureters must be visualized or identified by transillumination prior to energy application to prevent ureteric injury. CO2 laser vaporization (10,600 nm wavelength, focused beam) may be used as an alternative energy modality, offering precise tissue ablation with 0.1–0.5 mm lateral thermal spread, reducing collateral damage.

2. CO2 Laser Laparoscopy: Preferred in centers with advanced laser gynecology infrastructure (common in UAE tertiary centers and select Indian NABH-accredited hospitals). The laser is delivered through a dedicated laparoscopic coupler and allows simultaneous ablation of endometriotic implants, adhesiolysis, and LUNA in a single operative session. Tissue penetration depth is controlled by pulse duration and power settings (typically 15–30 W in superpulse mode), minimizing thermal artifact on adjacent peritoneum and neurovascular bundles.

3. Robotic-Assisted Laparoscopic LUNA (da Vinci System): Available at select JCI-accredited centers in India (Apollo, Fortis, Manipal) and UAE (Cleveland Clinic Abu Dhabi, Mediclinic City Hospital Dubai). Robotic assistance provides 3D stereoscopic visualization (10–15× magnification), articulated Endowrist instruments with 7 degrees of freedom, and tremor filtration — particularly advantageous when LUNA is combined with deep infiltrating endometriosis (DIE) excision, ureterolysis, or rectovaginal nodule resection. Robotic LUNA is the preferred approach when significant parametrial adhesions or anatomical distortion is anticipated.

PHASE 1 — PRE-TRAVEL & CONSULTATION (Weeks 1–3 Before Procedure):

• GAF Healthcare assigns a dedicated medical coordinator who reviews your complete medical records, imaging (TVUS, MRI pelvis), prior surgical reports, and pain history
• A virtual consultation is arranged with the treating gynecologist (laparoscopic or robotic surgery specialist) at the partner hospital in India or UAE
• Diagnostic gaps are identified: if diagnostic laparoscopy has not been previously performed, LUNA may be planned as part of a combined diagnostic-operative session
• Pre-travel medical clearance checklist issued; patients discontinue anticoagulants (if any) 5–7 days prior per anesthesiologist guidance
• E-Medical Visa (India) or UAE entry visa processing initiated by GAF Healthcare

PHASE 2 — ARRIVAL & PRE-OPERATIVE ASSESSMENT (Day 1–2 in Country):