Abstract
PurposeTo evaluate whether laparoscopic treatment with a diode laser is feasible, safe, and effective in symptomatic patients affected by deep endometriosis (DE).MethodsThis retrospective study was performed using medical record data. The surgical reports, chronic pain scores, and quality of life (QoL) data were evaluated for 50 patients who had undergone laparoscopic surgery between November 2017 and March 2019 at two university hospitals (Monserrato (CA) and Foggia, Italy). Indications for surgery were chronic pelvic pain and/or infertility in patients who wished to conceive spontaneously. Endometriosis lesions/nodules were excised using a diode laser (Leonardo®, Biolitec® DUAL 45) that can combine 980 and 1470 nm wavelengths transmitted through a 1000 µm conical optical fibre.ResultsThe median patient age was 32 years (range 21–44), with a body mass index (BMI) mean of 21.7 ± 2.9 kg/m2. The mean operation time was 147 min (range 106–190). No intraoperative or early complications (< 30 days) were reported. All patients left the hospital, on average, within 3 days (range 2–9 days) after surgery. A significant improvement in pain was observed at the 3-, 6-, and 12-month follow-up (p < 0.01) in all patients. Moreover, patients reported a significant QoL improvement at the 12-month follow-up.ConclusionThe diode laser confirmed its feasibility and safety for treating endometriosis. During the shaving surgical procedure, the diode laser system ensures a safe and effective laparoscopic dissection of deep endometriotic lesions. Further comprehensive randomized trials are necessary to confirm these preliminary data in terms of efficacy, recurrence rates, and pregnancy outcomes.
Highlights
Deep endometriosis (DE) is defined by the presence of endometriotic tissue over 5 mm in depth under the peritoneal surface [1]; it occurs in more than 20% of patients with endometriosis and often impairs fertility and quality of life (QoL) [2, 3]
A definitive diagnosis of DE was histologically confirmed by finding stroma and endometrial glands in the excised tissue
All the patients presented with chronic pain and had not responded to medical treatment for the pain; 30 patients (60%) had undergone prior abdominal surgery and 20 patients (40%) experienced infertility with the desire to conceive spontaneously
Summary
Deep endometriosis (DE) is defined by the presence of endometriotic tissue over 5 mm in depth under the peritoneal surface [1]; it occurs in more than 20% of patients with endometriosis and often impairs fertility and quality of life (QoL) [2, 3]. The presentation of DE often includes nodules that can affect the rectovaginal space, bowel, pelvic nerves, ureters, and/or bladder [9]; in rare conditions, DE may appear in other locations, such as the abdominal wall or thorax [10]. DE lesions can be single or multifocal and include symptoms such as dysmenorrhoea, chronic pelvic pain, dysuria, and dyschezia, in relation to. Involvement of the full thickness of the intestinal wall is unusual, but endometriosis may deeply infiltrate the muscularis, inducing a constriction of the intestinal lumen and severe obstructive symptoms [12]. Many researchers agree that DE surgical excision can improve pain symptoms and quality of life and may raise fertility chances [13,14,15,16,17,18]
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