Laparoscopic Modified Radical Hysterectomy for Severe Endometriosis: A Single-Center Case Series

Abstract

Study objectiveThe main objective is to describe the feasibility and report a single centre experience of a standardized laparoscopic modified radical hysterectomy technique among patients with severe endometriosis and pouch of Douglas obliteration. DesignA single-center case series of laparoscopic modified radical hysterectomy performed at the Poissy Hospital between December 2012 and May 2021. SettingsSingle-center, gynecology unit (level III) with a focus on endometriosis. PatientsPatients with severe endometriosis (stage 4 AFS) and pouch of Douglas Obliteration. Measurements and Main ResultsFifty-two patients with severe endometriosis underwent the surgical procedure.Out of these patients: 23.1% underwent a rectal shaving (n= 12), 1.9 % a discoid resection (n= 1) and 17.3% a rectal resection (n= 9), including a protective ileostomy in one case. Ureterolysis was performed on 82.7% of patients (n= 43). The average hospital stay was 3.3 days (1-12). Seven patients required intermittent self-catheterization (13.5%). Minor complications (Clavien-Dindo grade 1 and 2) occurred to 25.9% of the patients and severe complications to 3.8% of them (Clavien-Dindo grade 3, no grade 4). Two patients (3.8%) were reoperated: one for a postoperative occipital alopecia (balding) and the other for vaginal dehiscence with evisceration. About 50 patients (96.2%) had a complete resection of endometriosis. The median follow-up was 14 months (interquartile range 6-23 months) with 94.3% of them improved (much and very much) and 3.8% minimally improved. ConclusionIn our experience, laparoscopic modified radical hysterectomy is a reliable procedure with a low rate of severe complications. This technique needs to be assessed by other surgeons and others centers across the country and abroad, in order to determine the likehood of it succeeding.