Efficacy of Laparoscopic Partial Cystectomy with a Transurethral Resectoscope in Patients with Bladder Endometriosis: See-Through Technique

Abstract

Bladder endometriosis (BE) is rare. Deep invasive endometriosis is difficult to control with medications alone; such cases need surgical treatment. Good results of laparoscopic partial cystectomy with a transurethral (TU) resectoscope by the see-through technique for patients with BE are reported. Materials and Methods: From January 2008 to February 2016, 12 cases of symptomatic BE were seen in our institution. The chief complaints of 9 cases were micturition pain during menstruation. Preoperative cystoscopy showed a bladder mass with blueberry spots. All surgeries were performed under general anesthesia. Laparoscopic surgery was performed with a fan of 4 ports in the lower abdomen. First, the uterus and bilateral ovaries were checked. Then, the TU resectoscope was inserted. When the affected bladder wall was identified, it was again observed with the laparoscopic light source off, which made it possible to observe the twilight leaking inside from the bladder. This twilight came from the light source of the TU resectoscope via the unaffected bladder wall. In contrast, the thickness of the affected wall prevented the light from inside the bladder from passing through it. We call this the "see-through technique." The tumor was then safely dissected with both laparoscopic and TU resection procedures. Finally, the bladder was sutured by laparoscopic procedures using absorbable sterile surgical suture. The urethral catheter was removed after cystography 7 days after the operation. Results: The surgical margins of all cases were negative. There has been no recurrence of BE so far in any patients. There were no major adverse events perioperatively and the urinary symptoms improved in all cases. Conclusions: By laparoscopic partial cystectomy assisted with a TU resectoscope and see-through technique, the edge of BE could be easily and precisely identified. These procedures are effective and safe for BE surgical treatment.

Outcomes of Laparoscopic Partial Cystectomy of Bladder Endometriosis: A Report of 18 Thai Women

“…More interesting is the combination of cystoscopic and laparoscopic approaches to manage BE. Most recently, case reports 20 , 30 , 31 and case series 21 , 27 , 32 where this combination approach was used have been reported. The procedure named as “modified light-to-light technique” 27 or “See-Through technique” 21 is the simultaneous performance of TUR and LPC.…”

“…Most recently, case reports 20 , 30 , 31 and case series 21 , 27 , 32 where this combination approach was used have been reported. The procedure named as “modified light-to-light technique” 27 or “See-Through technique” 21 is the simultaneous performance of TUR and LPC. This procedure aims to overcome the limitations of each surgical technique toward a more beneficial outcome.…”

“…Therefore, it can completely remove the nodule without accidental removal of the healthy tissue. 12 , 21 , 27 …”

“…Evidence from the most recent publications utilizing the See-Through technique demonstrated complete excision of the nodule with no reported recurrence of the nodule after 20–32 months of follow-up. 21 , 27 Apart from the removal of the nodule, LPC can clinically relieve pain and urinary symptoms. 12 , 15 …”

“… 19 A few case reports and case series of LPC have been reported by Asian gynecologists and urologists. 20 , 21 The best surgical approach to DE remains unclear. 1 Therefore, we conducted a retrospective study to show the outcomes of LPC of BE in Thai women.…”