Laparoscopic Neuronavigation for Deep Lateral Pelvic Endometriosis: Clinical and Surgical Implications

Abstract

Study ObjectiveTo evaluate the clinical presentation and surgical outcome in patients with deep lateral pelvic endometriosis (dLPE). DesignA retrospective multicentric study (Canadian Task Force classification II-2). SettingUniversity tertiary referral centers. PatientsOne hundred forty-eight women with deep infiltrating endometriosis (DIE). InterventionsLaparoscopic excision of DIE. Disease distribution was classified as follows: central pelvic endometriosis (CPE) when DIE involved 1 of the following anatomic sites: cervix, vagina, uterosacral ligaments, rectum, bladder, or pelvic peritoneum; superficial lateral pelvic endometriosis when parametria, ureters, or hypogastric plexus were involved; and dLPE in the presence of sacral plexus and/or sciatic nerve infiltration. Measurements and Main ResultsAll patients showed CPE. LPE was detected in 116 cases (78.4%); among these, we observed dLPE in 41 patients (35.3%). dLPE occurred in 40% of women with CPE and in 72.7% of patients with hypogastric plexus involvement. Thirty women with dLPE (73.2%) received gastrointestinal or urologic resection in addition to gynecologic procedures compared with 40 patients (57.1%) without dLPE (p = .001). No differences were observed in terms of perioperative complications according to the presence of dLPE. According to univariate/multivariate analysis, chronic pelvic pain was the only predictor of dLPE (odds ratio = 3.041, p = .003). The median preoperative visual analog scale for dysmenorrhea (median = 8, range, 0–10) and dyspareunia (median = 5; range, 0–10) dropped to 0 after surgery. The median follow-up was 36 months (range, 6–66 months) with a recurrence rate of 8.8%. ConclusionsdLPE is not a rare event in women with DIE. Complete laparoscopic removal of endometriosis seems to ensure benefit in terms of recurrence rate without increased surgical morbidities.