Laparoscopic Management of Ureteral Endometriosis and Hydronephrosis Associated With Endometriosis

Alves, João; Puga, Marco; Fernandes, Rodrigo; Pinton, Anne; Miranda, Ignacio; Kovoor, Elias; Wattiez, Arnaud

doi:10.1016/j.jmig.2016.11.018

Cited by 31 publications

(24 citation statements)

References 31 publications

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“…For women with bowel endometriosis, laparoscopic bowel resection results in fewer complications compared with open bowel resection . A study of women with ureteral endometriosis also reported an increased risk of complications with a greater number of intraabdominal incisions such as a vaginotomy or cystotomy . These studies suggest that women with advanced stage, deep‐infiltrating, bowel or ureteral endometriosis have an increased risk of complications with certain concomitant procedures, but no study has investigated predictors of complications in all women undergoing laparoscopic treatment of endometriosis.…”

Section: Introductionmentioning

confidence: 99%

“…11 A study of women with ureteral endometriosis also reported an increased risk of complications with a greater number of intraabdominal incisions such as a vaginotomy or cystotomy. 12 These studies suggest that women with advanced stage, deep-infiltrating, bowel or ureteral endometriosis have an increased risk of complications with certain concomitant procedures, but no study has investigated predictors of complications in all women undergoing laparoscopic treatment of endometriosis. We sought to examine all women undergoing surgical treatment of presumed as well as pathologically confirmed endometriosis to determine if any unique patient or procedure characteristics could predict major complications, thereby aiding in surgical planning or perioperative counseling.…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic treatment of endometriosis and predictors of major complications: A retrospective cohort study

Clark

Dmello

Griffith

et al. 2019

Acta Obstet Gynecol Scand

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Introduction Patients with advanced endometriosis may be at an increased risk of surgical complications following laparoscopic treatment of endometriosis; however, this relationship has not been examined. We sought to identify predictors of major complications following laparoscopic treatment of endometriosis. Material and methods A retrospective cohort study of women who underwent laparoscopic treatment of suspected endometriosis between 2009 and 2016 within the Division of Minimally Invasive Gynecologic Surgery at Brigham and Women’s Hospital, Boston, MA, USA. Predictors of major perioperative complications were assessed by comparing the characteristics of women who had any major intraoperative or postoperative complication with those of women who had no complication. Results A total of 397 women underwent laparoscopic treatment of suspected endometriosis including excision of superficial endometriosis (55.4%), excision of deep‐infiltrating endometriosis (24.9%), fulguration of endometriosis (38.3%), hysterectomy (23.2%), ovarian cystectomy (35.5%), salpingectomy (18.6%), oophorectomy (15.1%), and bowel resection (1.0%). Women were followed for 60 days following surgery, over which time 18 women (4.5%) had a major perioperative complication. Patient characteristics and preoperative imaging were similar between women with and without complications. Women with advanced endometriosis, including stage III or IV endometriosis, deep‐infiltrating endometriosis, or rectovaginal disease, were more likely to have a complication, though this did not reach statistical significance (77.8% of women with a complication versus 56.7% of women without a complication had advanced endometriosis, P = 0.077). Women who had a complication were more likely to have undergone adhesiolysis or ureterolysis (88.9% of women with a complication versus 52.5% without a complication underwent adhesiolysis, P = 0.002; and 61.1% of women with a complication versus 28.8% without a complication underwent ureterolysis, P = 0.003). The total number of procedures was greater for women who had a complication (4.3 ± 1.2 vs 3.2 ± 1.5, P = 0.003). All other procedure characteristics were similar between women with and without complications. Conclusions Complications following laparoscopic treatment of suspected endometriosis could not be predicted by preoperative patient characteristics or surgical findings of advanced endometriosis. Adhesiolysis, ureterolysis, and an increased number of total procedures may be predictive of perioperative complications, suggesting that surgical complexity as measured by the procedures performed, rather than the disease severity, may increase the risk of a complication compared with women who do not undergo these procedures.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Laparoscopic treatment of endometriosis and predictors of major complications: A retrospective cohort study

Clark

Dmello

Griffith

et al. 2019

Acta Obstet Gynecol Scand

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“…Deep-infiltrating endometriosis (DIE) affects about 20% of patients with endometriosis. Its clinical behavior is extremely heterogeneous ranging from an asymptomatic finding to a severe disorder involving multiple extragenital organs and causing symptoms as infertility, deep dyspareunia or chronic pelvic pain in 50% of cases ( 1 ). DIE negatively impacts the physical status of patients, their psychological and social quality of life ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

Robotic Approach to Ureteral Endometriosis: Surgical Features and Perioperative Outcomes

et al. 2018

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Introduction: Surgical treatment of ureteral endometriosis is necessary to relieve urinary symptoms of obstruction and to preserve renal function. Which surgical approach to ureteral endometriosis should be considered the most appropriate is debated, due to the lack of scientific evidence. The aim of the present study is to assess the feasibility and to describe the perioperative outcomes of minimally invasive treatment of deep ureteral endometriosis using robotic assistance, highlighting the technical benefits and the limits of this approach.Method: A case-series including 31 consecutive patients affected by high-stage endometriosis including ureteral endometriosis using robotic assistance in our Department between November 2011 and September 2017.Results: All procedures were successfully completed by robotic technique, resulting in full excision of the parametrial nodules involving the ureter. Mean operating time was 184.8 ± 81 min. Mean hospital stay was 4.02 ± 3 days. Perioperative complications occurred in five patients and 4 out of 5 involved the urinary tract.Conclusions: Robotic surgery for deep infiltrating endometriosis of the ureter was feasible and allowed complete resection of ureteral nodules in all cases. No intraoperative complications arose, but a non-negligible rate of urinary tract complications was detected. This calls for a careful assessment of the benefits and specific risks associated with the use of robotic surgery for the treatment of deep infiltrating endometriosis of the ureter.

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“…24 We could suggest that the presence of multiple disease locations and the involvement of the posterior compartment of the pelvis increase the surgical difficulty and as a consequence the possibility of complications. 33…”

Section: Discussionmentioning

confidence: 99%

Effect of Anterior Compartment Endometriosis Excision on Infertility

Centini

Afors

Alves³

et al. 2018

JSLS

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Background and Objectives:Laparoscopic surgical excision of bladder nodules has been demonstrated to be effective in relieving associated painful symptoms; the data are lacking concerning the impact of anterior compartment endometriosis on infertility. We conducted this study to evaluate whether or not the surgical excision of deep endometriosis affecting the anterior compartment plays a role in restoring fertility.Methods:This multicentre, retrospective study included a group of 55 patients presenting with otherwise-unexplained infertility who had undergone laparoscopic excision of anterior compartment endometriosis with histological confirmation. Patient medical records and operative reports were reviewed. Telephone interviews were conducted for long-term followup of fertility outcomes.Results:The pregnancy rate following surgical excision of endometriotic lesions was 44% (n = 11) among those with anterior compartment involvement alone and 50% (n = 15) in case of posterior lesions association without any significant difference. The symptoms related to bladder endometriosis resolved in the 84.2% of the cases with a recurrence rate of 1.8% at the 2-year followup not requiring further surgery.Conclusion:Laparoscopic excision of anterior compartment endometriosis is effective in restoring fertility in patients with otherwise-unexplained infertility and in treating endometriosis-related symptoms.

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Laparoscopic Management of Ureteral Endometriosis and Hydronephrosis Associated With Endometriosis

Cited by 31 publications

References 31 publications

Laparoscopic treatment of endometriosis and predictors of major complications: A retrospective cohort study

Laparoscopic treatment of endometriosis and predictors of major complications: A retrospective cohort study

Robotic Approach to Ureteral Endometriosis: Surgical Features and Perioperative Outcomes

Effect of Anterior Compartment Endometriosis Excision on Infertility

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