Posterior Deep Infiltrating Endometriotic Nodules: Operative Considerations according to Lesion Size, Location, and Geometry, during One’s Learning Curve

Abstract

We conducted this prospective cohort study to standardize our laparoscopic technique of excision of posterior deep infiltrating endometriosis (DIE) nodules, according to their size, location, and geometry, including 36 patients who were grouped, according to principal pelvic expansion of the nodule, into groups with central (group 1) and lateral (group 2) lesions, and according to nodule size, into ≤2 cm (group A) and >2 cm (group B) lesions, respectively. In cases of group 1 the following operative steps were more frequently performed compared to those of group 2: suspension of the rectosigmoid, colpectomy, and placement of bowel wall reinforcement sutures. The opposite was true regarding suspension of the adnexa, systematic ureteric dissection, and removal of the diseased pelvic peritoneum. When grouping patients according to nodule size, almost all of the examined parameters were more frequently applied to patients of group B: adnexal suspension, suspension of the rectosigmoid, systematic ureteric dissection, division of uterine vein, colpectomy, and placement of bowel wall reinforcement sutures. Nodule size was the single most important determinant of duration of surgery. In conclusion, during the building-up of one's learning curve of laparoscopic excision of posterior DIE nodules, technique standardization is very important to avoid complications.

Case Report: A Laparoscopic Treated Case of Deep Infiltrating Endometriosis with Vaginal Invasion Diagnosed by Vaginal Cytology

“…As DIE nodules are generally rich in nerve fibers [12], patients with DIE suffered from severe pelvic pain, such as dysmenorrhea and deep dyspareunia [13]- [15]. The medical therapies may temporally alleviate painful symptoms, however recurrence rates after the discontinuation are reported to be high [4] [16]. Thus, radical surgical excisions for DIE lesion are thought to be the mainstay of the treatment for this type of endometriosis.…”

“…Thus, radical surgical excisions for DIE lesion are thought to be the mainstay of the treatment for this type of endometriosis. Although laparoscopic approaches appear to be the ideal tool to perform such surgeries for DIE, approaches for DIE nodules are real operative challenge due to common involvement of retroperitoneal structures (ureter, bowel, vessels and nerves) [4]. After the surgery, half of the patients wishing for her babies were reported to conceive spontaneously, suggesting a relationship between DIE and infertility [17].…”

“…DIE nodules represent a real operative challenge due to common involvement of vital structures, such as ureter, bowel, vessels and nerves. Laparoscopy appears to be an ideal tool to perform such surgery, offering the advantages of magnification, accurate hemostasis, precise dissection and fertility [4].…”

Feasibility Profile of Endometrial Nodule Resection in the Uterosacral and Rectovaginal Ligament

“…Data yang tersedia ditampilkan secara deskriptif. 4 Nevertheless, laparoscopic management of retroperitoneal endometriosis should not be undertaken by inexperienced surgeon. Good knowledge of pelvic retroperitoneal anatomy is a prerequisite for radical and uncomplicated removal of DIE nodules.…”

Novel agents for the medical treatment of endometriosis

“…It can be technically demanding and carries an associated risk of severe complications [5,6]. Although surgery can improve endometriosis-associated pain and infertility, the long-term benefit of surgery is still not clear in terms of symptom management and clinical outcome.…”