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Laparoscopic Neuronavigation for Deep Lateral Pelvic Endometriosis: Clinical and Surgical Implications.

Abstract：

STUDY OBJECTIVE:To evaluate the clinical presentation and surgical outcome in patients with deep lateral pelvic endometriosis (dLPE). DESIGN:A retrospective multicentric study (Canadian Task Force classification II-2). SETTING:University tertiary referral centers. PATIENTS:One hundred forty-eight women with deep infiltrating endometriosis (DIE). INTERVENTIONS:Laparoscopic excision of DIE. Disease distribution was classified as follows: central pelvic endometriosis (CPE) when DIE involved 1 of the following anatomic sites: cervix, vagina, uterosacral ligaments, rectum, bladder, or pelvic peritoneum; superficial lateral pelvic endometriosis when parametria, ureters, or hypogastric plexus were involved; and dLPE in the presence of sacral plexus and/or sciatic nerve infiltration. MEASUREMENTS AND MAIN RESULTS:All patients showed CPE. LPE was detected in 116 cases (78.4%); among these, we observed dLPE in 41 patients (35.3%). dLPE occurred in 40% of women with CPE and in 72.7% of patients with hypogastric plexus involvement. Thirty women with dLPE (73.2%) received gastrointestinal or urologic resection in addition to gynecologic procedures compared with 40 patients (57.1%) without dLPE (p = .001). No differences were observed in terms of perioperative complications according to the presence of dLPE. According to univariate/multivariate analysis, chronic pelvic pain was the only predictor of dLPE (odds ratio = 3.041, p = .003). The median preoperative visual analog scale for dysmenorrhea (median = 8, range, 0-10) and dyspareunia (median = 5; range, 0-10) dropped to 0 after surgery. The median follow-up was 36 months (range, 6-66 months) with a recurrence rate of 8.8%. CONCLUSIONS:dLPE is not a rare event in women with DIE. Complete laparoscopic removal of endometriosis seems to ensure benefit in terms of recurrence rate without increased surgical morbidities.

journal_name

J Minim Invasive Gynecol

journal_title

Journal of minimally invasive gynecology

authors

Chiantera V,Petrillo M,Abesadze E,Sozzi G,Dessole M,Catello Di Donna M,Scambia G,Sehouli J,Mechsner S

doi

10.1016/j.jmig.2018.02.015

subject

Has Abstract

pub_date

2018-01-01 00:00:00

pages

1217-1223

issue

eissn

1553-4650

issn

1553-4669

pii

S1553-4650(18)30145-6

journal_volume

pub_type

杂志文章,多中心研究

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Laparoscopic Neuronavigation for Deep Lateral Pelvic Endometriosis: Clinical and Surgical Implications.