Use of laparoscopic modified nerve-sparing radical hysterectomy for the treatment of extensive endometriosis

Abstract

INTRODUCTION: Endometriosis is an estrogen-dependent chronic inflammatory condition affecting 6-10% of reproductive-aged women. Chronic pelvic pain impacts the quality of life of patients with endometriosis. Here, we describe the use of laparoscopic modified radical hysterectomy for the treatment of extensive and deeply infiltrating endometriosis. METHODS: A retrospective chart review was conducted on patients with Stage IV endometriosis who underwent laparoscopic modified radical hysterectomy. All patients had a history of extensive endometriosis that failed medical and conservative surgical treatment and caused significant recurrent symptoms. The objective of this study is to show the feasibility of treatment of Stage IV endometriosis by laparoscopic modified radical hysterectomy. RESULTS: A total of 52 patients underwent laparoscopic modified nerve-sparing radical hysterectomy for endometriosis between October 2006 and September 2013. The most common preoperative symptom was chronic pelvic pain. Adjunctive procedures, including salpingo-oophorectomy, appendectomy, disc excision of the bowel and ureteroneocystostomy, and in one case bowel resection, were performed as indicated. Mean patient age was 44 years (range 32-55). Mean hospital stay was one day (range 0-3). Postoperative complications included one case of urinary retention, one vaginal cuff abscess, and one infected ureteral stent. Mean follow-up was 33 months (range 13-65). Out of 52 patients, 33 had at least one prior surgery for the treatment of endometriosis. All patients reported dramatic pain relief, and there were no reports of symptom recurrence. CONCLUSION: In cases of severe endometriosis, the use of laparoscopic modified nerve-sparing radical hysterectomy is a feasible and effective method for achieving long-term improvement in pain symptoms. There was no difference noted between symptom recurrences in the group of patients with bilateral salpingo-oophorectomy versus those with ovarian conservation in contrast to prior studies. Of note, 14 patients underwent bilateral oophorectomy, nine patients underwent unilateral oophorectomy, and two patients underwent removal of ovarian remnant.