Technique and Initial Results of the Laparoscopic Nerve Sparing Ultralateral Resection (LaNSURe) of Parametrial Endometriosis

Abstract

Study Objective Parametrial endometriosis (PE) is a poorly understood and under-recognized form of deeply infiltrating endometriosis and represents a suspected cause of persistent pelvic pain after traditional excision of endometriosis. The detailed description of the clinical symptoms and signs associated with this presentation of the disease, as well as the success rate of the outcomes of the radical LaNSURe treatment strategy will contribute to closing a substantial gap in endometriosis care in Canada. Design Retrospective-prospective cohort study of patients undergoing a surgical intervention (Canadian Task Force II-3). Setting Tertiary Referral Center. Patients or Participants Interim analysis of an ongoing retrospective-prospective study that currently includes 28 patients who underwent the LaNSURe technique for the treatment of pathology-confirmed PE. Interventions Radical laparoscopic treatment of endometriosis, including a unilateral or bilateral parametrectomy using the Laparoscopic Nerve-Sparing Ultralateral Resection of Endometriosis (LaNSURe) technique. Measurements and Main Results Before each preoperative visit, patients filled out a questionnaire which included Visual Analog Scale (VAS) to report the average pain they experience, the maximum pain during flare ups and the minimal pain they feel as well as specific health-related quality of life questionnaires. The primary outcome was the average VAS scores before surgery and at the last postoperative visit. Mean follow-up time was 4.3±2.1 months. The Average VAS post-surgery significantly decreased from preoperative 5.9±1.9 to 4.0±2.5 (p=0.004). Maximum pain went down from 7.9±2.2 to 5.3±3.0; (p=0.001). McGill Pain Questionnaire improved from 34.6±19.5 to 23.5±15.9 (p=0.04), Pain Catastrophizing Scale from 28.4±12.7 to 16.4±14.9 (p=0.005), and Pelvic Floor Distress Inventory from 164.7±44.3 to 136.2±40.6 (p=0.03). Twenty out of 28 (71.4%) patients underwent one or more previous excision surgery by an endometriosis specialist. Conclusion The LaNSURe technique is effective at improving overall pain and quality of life while preserving nerve function in the pelvic floor.