Parametrial Endometriosis: Assessing the Efficacy of the Laparoscopic Nerve-Sparing Ultralateral Resection (LaNSURe) Technique

Abstract

<h3>Study Objective</h3> Parametrial endometriosis (PE) is specific presentation of deeply infiltrating endometriosis (DIE) that infiltrates the parametria laterally toward the pelvic sidewall. It can affect the levator ani muscles, obturator internus, sacral nerve roots, pudendal and/or the sciatic nerve. These structures are innervated by somatic nerves; therefore, their infiltration produces somatic-type pain, as opposed to the viscaeral pain classically seen in DIE and demands a different surgical strategy. The objective of this study is to characterize the clinical presentation of patients with PE and assess the outcomes of the LaNSURe treatment strategy. <h3>Design</h3> Retrospective-prospective cohort study of patients undergoing a surgical intervention (Canadian Task Force II-3). <h3>Setting</h3> Tertiary Academic Referral Center. <h3>Patients or Participants</h3> Thirty-seven patients who underwent a LaNSURe for treatment of PE. <h3>Interventions</h3> Radical treatment of PE using the LaNSURe technique. <h3>Measurements and Main Results</h3> Visual Analog Scale (VAS) was used to assess minimum, average, and maximum pain. The primary outcome was pain level change from before surgery to the last follow up visit available. Mean follow-up time was 10.05±3.28 months. Secondary outcomes were the scores of the four validated specific health-related quality of life questionnaires Pain VAS scores significantly reduced (p<.001) from preoperative to postoperative follow up: average pain from 5.75±1.94 to 2.89±2.53; maximum pain from 7.93±2.16 to 4.50±3.34; and minimum pain from 3.79±2.66 to 1.54±1.79. McGill Pain Questionnaire improved from 32.08±19.83 to 18.44±15.15 (p=0.01), Pain Catastrophizing Scale from 26.58±14.35 to 13.77±14.91 (p=0.0027), and Pelvic Floor Distress Inventory from 157.81±44.11 to 129.72±37.70 (p=0.017). Twenty eight out of 37 (75.7%) patients had undergone one or more previous excision surgery, with 67.6% done by an endometriosis specialist, and experienced persistent PE symptoms. <h3>Conclusion</h3> The LaNSURe technique is effective at improving overall pain and quality of life while preserving nerve function in the pelvic floor.