Parametrial Endometriosis Part 1: A Correlation of Parametrial Anatomy and Disease Presentation

Abstract

Study Objective This is the first video of a series introducing the concept of Parametrial Endometriosis (PE) and describing our approach to diagnosing and treating this particular disease presentation. The objective of this video is to discuss the anatomy and innervation of the parametrium, introduce the concept of PE and explain the presenting signs and symptoms associated to this condition. Design Educational video that introduces the concept of PE, a specific pattern of endometriosis with a unique constellation of symptoms. Setting Compilation of anatomy schematics, surgical video clips from a tertiary centre, and cadaveric dissections demonstrating the anatomy in the innervation of the parametrium and its correlation with the specific symptoms and signs of PE. Patients or Participants This video is part of an ongoing restrospective-prospective study that currently includes 28 patients who underwent surgical parametrectomies for the treatment of PE. Video images have been extracted from such patients, as well as from cadaveric dissections performed by the senior author. Interventions Anatomy schematics and surgical and cadaveric dissection video clips demonstrating the anatomy and innervation of the parametria, describing the infiltration patterns of PE and correlating the anatomy with the clinical features of this disease presentation. Measurements and Main Results PE infiltrates towards the pelvic sidewall and intrapelvic portions of the lumbosacral plexus producing symptoms such as lateral hip, sacral, groin and posterior thigh pain. It is often associated with neuropathic symptoms such as pudendal neuralgia, sciatica, urinary urgency and frequency, dyschezia and proctalgia. Conclusion PE is a unique presentation of endometriosis with a specific constellation of symptoms. This video series introduces this concept and sets the fundamental anatomic bases for the next videos in the series, which describe the diagnosis, as well as the surgical technique and results of the Laparoscopic Nerve-Sparing Ultralateral Resection (LaNSURe) of PE.