Cystoscopy-assisted laparoscopy for bladder endometriosis: modified light-to-light technique for bladder preservation

Abstract

Introduction Endometriosis is a disease with causes still unclear, affecting approximately 15% of women of reproductive age, and in 1%-2% of whom it may involve the urinary tract. The bladder is the organ most frequently affected by endometriosis, observed around 85% of the cases. In such cases, the most effective treatment is partial cystectomy, especially via videolaparoscopy.Study Objective, Design, Size and Duration In order to identify and delimit the extent of the intravesical endometriosis lesion, to determine the resection limits, as well as to perform an optimal reconstruction of the organ aiming for its maximum preservation, we performed a cystoscopy simultaneously with the surgery, employing a modified light-to-light technique in 25 consecutive patients, from September 2006 to May 2012.Setting Study performed at Campinas Medical Center – Campinas – Sao Paulo – Brazil.Participants/materials, setting and methods: Patients aged 27 to 47 (average age: 33.4 years) with deep endometriosis with total bladder involvement were selected for the study. The technique used was conventional laparoscopy with a transvaginal uterine manipulator and simultaneous cystoscopy (the light-to-light technique). A partial videolaparoscopic cystectomy was performed with cystoscopy-assisted vesical reconstruction throughout the entire surgical time. The lesions had an average size of 2.75cm (ranging from 1.5 to 5.5cm). The average surgical time was 137.7 minutes, ranging from 110 to 180 minutes.Main Results Postoperative follow-up time was 32.4 months (12-78 months), with clinical evaluation and a control cystoscopy performed every six months. No relapse was observed during the follow-up period.Conclusions A cystoscopy-assisted partial laparoscopic cystectomy with a modified light-to-light technique is a method that provides adequate identification of the lesion limits, intra or extravesically. It also allows a safe reconstruction of the organ aiming for its maximum preservation.

Resection of a large endometriotic nodule of the bladder using a combined laparoscopic and cystoscopic approach (“light to light technique”)

“…It's a safe and a feasible option in experienced hands. Similar technique has been reported in a case report in Australia 2 and Brazil in a case series of 25 patients 3 where the average surgical time was 137 minutes, with no relapse over 32 months of average follow up. This is the first reported case in Sri Lanka of this method.…”

Case report and surgical video presentation: Combined laparoscopic and cystoscopic partial bladder cystectomy for excision of deeply infiltrating endometriosis

“…A combination of cystoscopy and laparoscopy is a safe and feasible procedure, with a low rate of complications reported in the current literature [ [4] , [5] , [6] , [7] ]. It represents the ideal way in which to identify the resection limits for complete excision of the lesion and allows for optimal repair of the bladder defect [ 8 , 9 ], and is superior to the alternative option of excision via laparoscopy alone as it allows better delineation of the lesion. It is of course important to counsel the patient preoperatively and engage appropriately trained personnel.…”

Endometriosis of the Urinary Bladder Causing a Right Hydronephrosis: A Case Report

“…In addition, recent studies have shown that the management of urinary bladder endometriosis is quite challenging. The literature supports that the most effective treatment of bladder endometriosis is a partial cystectomy via video-laparoscopy, with the advantages of laparoscopy procedures and generally satisfactory outcomes [12–14]. Along with the surgical management, a review article was conducted in 2017 in Italy, suggesting another treatment of bladder endometriosis besides partial cystectomy.…”