Management Of Deep Endometriosis Research Articles

Efficacy between Conventional Laparoscopy and Robotic Surgery in Mexican Patients with Endometriosis: A Comparative Study.

Background. Surgical management of endometriosis is essential, and deep endometriosis involves the invasion of endometrial tissue into other organs such as the bladder, ureters, and rectum. In Latin American countries, significant expertise has been achieved in conventional laparoscopy (CL); however, there is less experience in robot-assisted laparoscopy (RAL) because of the high cost of this technique. For this reason, studies comparing CL and RAL for the treatment of deep endometriosis in patients are scarce, making this study the first to share the experience of Mexican patients. Aim. The efficacy of CL vs. RAL in the management of deep endometriosis in Mexican patients was compared. Materials and Methods. We performed a retrospective and comparative study. We considered all patients treated with minimally invasive surgery for deep endometriosis between 2015 and 2023. Results. A total of 93 patients were included; 56 patients were treated with CL, and 37 patients were treated with RAL. A significant difference (p < 0.05) was observed in the postoperative length of stay, which was longer in patients treated with CL compared with those treated with RAL. Additionally, postoperative pain was less frequent in patients treated with RAL than in those treated with CL (p < 0.05). We did not observe a significant difference in operative time, blood loss, or perioperative complications between the two surgical techniques (p < 0.05). Conclusions. CL and RAL are effective methods for managing endometriosis in Mexican patients; however, RAL is beneficial for the treatment of deep endometriosis because patients experience postoperative pain less frequently than CL patients and have a shorter postoperative length of stay.

Management of deep endometriosis: in favour of a single, planned, coordinated and concerted surgical procedure

Management of deep endometriosis: in favour of a single, planned, coordinated and concerted surgical procedure

8883 Total Laparoscopic Bladder Resection in the Management of Deep Endometriosis: “Take It or Leave It.”

<h3>Study Objective</h3> To highlight laparoscopic surgical anatomy for bladder resection in deep endometriosis (DE). <h3>Design</h3> Video article. <h3>Setting</h3> Laparoscopic 4K OR in IRCCS Sacro Cuore Don Calabria Hospital, Trendelenburg position under general anesthesia. <h3>Patients or Participants</h3> 35 years old woman complaining chronic pelvic pain and urinary specific symptoms, looking for pregnancy for 4 years. <h3>Interventions</h3> Opening and development of paravescical spaces, Bogros and Retzius spaces, bladder nodule isolation and resection of the whole-thickness portion of the nodule. En-bloc posterior eradication of DE after opening and development of para-rectal space and recto-vaginal space. <h3>Measurements and Main Results</h3> Duration of the surgical procedure was 180 minutes, blood loss 50cc, inpatient stay 12 days, Foley catheter was removed after 7 days (cystography was performed to assess bladder closure). <h3>Conclusion</h3> Laparoscopic bladder resection might be less invasive and precise if anatomical spaces are properly prepared and the resection is limited to the infiltrating portion of the nodule.

Deep Endometriosis of the Bowel: A Surgical Approach

Video Objective The objectives of this video are to define bowel endometriosis and to explore various surgical parameters for the different types of surgical excision. Then, a specific surgical approach will be demonstrated. Setting Our case is of a 34 year old nulliparous woman who presented for surgical management of deep endometriosis, as she was unable to tolerate medical management. She also presented with rectal bleeding and fecal urgency. This case was performed at a tertiary care setting hospital in Canada. Interventions Surgical management of bowel endometriosis is indicated for symptom and pain relief, intolerance to medical management and to prevent complete obstruction. Importantly, operative planning and management should involve a multidisciplinary team involving gynecologists, general or colorectal surgeons and radiologists. When planning a surgical approach to deep endometriosis of the bowel, patient characteristics such as age and BMI, as well as their specific symptoms and level of pain, quality of life and fertility goals must be considered. As well, the actual lesion must be investigated with respect to size, number, location, depth of infiltration, and amount of intestinal wall circumference involved. Then, various surgical techniques can be performed depending on these specific characteristics, such as nodule shaving, nodular resection and segmental resection and re-anastomosis. For our surgical case, segmental resection and re-anastomosis was indicated after intra-operative colonoscopy showed significant luminal obstruction. The video demonstrates a blood vessel preservation and nerve sparing approach, highlighting blood supply, sympathetic and para-sympathetic innervation. Conclusion The patient was discharged post-operative day 2 and reported complete resolution of symptoms at her clinical follow-up. This surgical video demonstrates and advocates a multidisciplinary approach to bowel endometriosis to improve patient quality of life.

Total laparoscopic bladder resection in the management of deep endometriosis: "take it or leave it." Radicality versus persistence.

Bladder endometriosis (BE) is the most common external site of deep-infiltrating endometriosis (DIE) affecting the urinary tract. Frequently associated with other DIE lesions, it can be strongly related to a ventral spread of adenomyosis. Possible symptoms are urinary frequency, tenesmus and hematuria, and they are frequently related to DIE of the posterior and lateral compartment. Hormonal therapy can be used in non-symptomatic patients; conversely, in other cases surgical treatment is the management of choice. Retrospective cohort study of a series of consecutive patients treated between September 2004 and December 2017 in a tertiary care referral center. Only full-thickness detrusor involvement was considered as BE. All patients underwent laparoscopic bladder resection with concomitant radical excision of DIE. BE was found in 264 patients and was associated with simultaneous bowel DIE requiring bowel resection in 140 patients (53%). Twenty-five patients (9.5%) had associated obstructive ureteral signs requiring ureteroneocystostomy. Mean hospital stay and time of catheter removal were 9.7 and 9.1days, respectively. Postoperative major complications (< 28days) were observed in 19 patients (7.2%). Follow-up was performed at 1, 6 and 12months after surgery, with a 2.3% recurrence rate observed. Laparoscopic partial cystectomy for BE is a feasible and safe technique, and experienced laparoscopic surgeons should consider it the gold standard treatment. Surgical eradication leads to excellent surgical outcomes in terms of reduction of symptoms and recurrence rates, considering the need to maintain an adenomyotic uterus for fertility purposes.

The Impact of Laparoscopic Surgical Management of Deep Endometriosis on Fertility Outcome.

The Impact of Laparoscopic Surgical Management of Deep Endometriosis on Fertility Outcome.

Deep endometriosis infiltrating the recto-sigmoid: critical factors to consider before management.

Deep endometriosis invading the bowel constitutes a major challenge for the gynecologist. In addition to the greater impact on pain, the high incidence of surgical morbidity involved with bowel endometriosis poses a therapeutic dilemma for the surgeon. Intestinal involvement by deep endometriotic nodules has been estimated to occur in 8-12% of women with endometriosis. Individual and clinical factors, pre-operative morphologic characteristics from imaging, surgical considerations and impact on quality of life are critical variables that should be considered in determining the best therapeutic strategy for a patient with deep endometriosis involving the sigmoid and/or the rectum. Pre-operative planning is fundamental for defining the optimal therapeutic strategy; patient counseling of treatment options, and when surgery is indicated, involvement of a multidisciplinary surgical team is required. The PubMed and Cochrane database were searched for all original and review articles published in English, French and Italian, until June 2014. Search terms included 'deep endometriosis', 'surgical and clinical approach', 'bowel disease', 'quality of life', 'management of deep endometriosis'. Special attention was paid to articles comparing features of discoid and segmental resection. The rationale for the best therapeutic options for patients with deep endometriosis has been shown and an evidence-based treatment algorithm for determining when and which surgical intervention may be required is proposed. In deciding the best treatment option for patients with deep endometriosis involving the sigmoid and rectum, it is important to understand how the different clinical factors and pre-operative morphologic imaging affect the algorithm. Surgery is not indicated in all patients with deep endometriosis, but, when surgery is chosen, a complete resection by the most appropriate surgical team is required in order to achieve the best patient outcome. In women with deep endometriosis, surgery is the therapy of choice for symptomatic patients when deep lesions do not improve with a medical treatment.

Fertility Outcome after Surgical Management of Deep Endometriosis

Fertility Outcome after Surgical Management of Deep Endometriosis

Management of deep endometriosis.

Deep endometriosis is defined as an endometriotic lesion that penetrates the retroperitoneal space for a distance of > or =5 mm. Deep endometriosis is extremely active, occurs in phase with eutopic endometrium, evolves progressively with age, and is most often located in the pouch of Douglas, the rectovaginal septum, the uterosacral ligaments, and occasionally in the uterovesical fold. These lesions are associated with pelvic pain, the intensity of which is proportional to the depth of penetration. It is clear that choice of treatment depends on the location of the endometriotic lesion. In this paper we describe our methods for the initial diagnosis and subsequent treatment of deep endometriosis. These include consultation and clinical examination protocols, use of rectal endoscopic ultrasonography (EUS), magnetic resonance imaging (MRI), and transvaginal ultrasonography techniques in diagnosis and surgical treatment approaches.