scholarly journals Full-Thickness Excision versus Shaving by Laparoscopy for Intestinal Deep Infiltrating Endometriosis: Rationale and Potential Treatment Options

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Antonio Simone Laganà ◽  
Salvatore Giovanni Vitale ◽  
Maria Antonietta Trovato ◽  
Vittorio Italo Palmara ◽  
Agnese Maria Chiara Rapisarda ◽  
...  
Keyword(s):  
Uterine Cavity ◽  
Laparoscopic Approach ◽  
Deep Infiltrating Endometriosis ◽  
Full Thickness ◽  
Intestinal Endometriosis ◽  
Deep Endometriosis ◽  
Uterosacral Ligaments ◽  
Intestinal Involvement ◽  
Full Thickness Excision ◽  
Infiltrating Endometriosis

Endometriosis is defined as the presence of endometrial mucosa (glands and stroma) abnormally implanted in locations other than the uterine cavity. Deep infiltrating endometriosis (DIE) is considered the most aggressive presentation of the disease, penetrating more than 5 mm in affected tissues, and it is reported in approximately 20% of all women with endometriosis. DIE can cause a complete distortion of the pelvic anatomy and it mainly involves uterosacral ligaments, bladder, rectovaginal septum, rectum, and rectosigmoid colon. This review describes the state of the art in laparoscopic approach for DIE with a special interest in intestinal involvement, according to recent literature findings. Our attention has been focused particularly on full-thickness excision versus shaving technique in deep endometriosis intestinal involvement. Particularly, the aim of this paper is clarifying from the clinical and methodological points of view the best surgical treatment of deep intestinal endometriosis, since there is no standard of care in the literature and in different surgical settings. Indeed, this review tries to suggest when it is advisable to manage the full-thickness excision or the shaving technique, also analyzing perioperative management, main complications, and surgical outcomes.

Deep infiltrating endometriosis: Interest of the robotic approach for a fledgling team

2019 ◽  
Vol 11 (3) ◽  
pp. 152-157
Author(s):  
Julie Poujois ◽  
Cécile Mézan De Malartic ◽  
Ronan Callec ◽  
Laurent Bresler ◽  
Nicolas Hubert ◽  
...  
Keyword(s):  
Laparoscopic Approach ◽  
Deep Infiltrating Endometriosis ◽  
Robotic Assistance ◽  
Deep Endometriosis ◽  
Surgical Assistance ◽  
Surgical Data ◽  
The Mean ◽  
Infiltrating Endometriosis

Introduction: Mini-invasive surgery of deep endometriosis is challenging. Surgical difficulties related to the technical limitations of classical laparoscopic approach might be overcome with the use of robotic assistance. The aim of this study was to evaluate the safety and feasibility of robotic surgery for deep infiltrating endometriosis in the learning phase of our team. Methods: The 20 first cases of robotic-assisted laparoscopies for endometriosis were included over a 2-year period. Baseline characteristics of patients and surgical data were reviewed. Surgical outcomes and follow-up information of the patients were analyzed. Results: Twenty women were included. The mean age was 31.9 years (range: 25–44) and mean body mass index was 23 kg/m2 (range: 16–35). Ten patients had rectovaginal or uterosacral location only (50%) and nine women had deep infiltrating endometriosis with digestive or urinary tract lesions (45%). In addition to the gynecologic surgeon, urologic or visceral surgeons were required in 10 cases, and there were 3 cases where the three specialties were needed. The mean operative time was 183.9 min (range: 85–398) and no difference was observed between the first five cases and the last five cases. There was one laparoconversion, and only two urologic postoperative complications occurred. Conclusion: Thanks to the use of robotic surgical assistance and a multidisciplinary approach, and despite the start of the team for deep endometriosis care, no learning curve effect was observed regarding surgical procedures’ success, safety, or duration. The use of robotic assistance might improve the quality of care for women facing deep endometriosis.

scholarly journals Diagnosis and treatment of deep infiltrating endometriosis with bowel involvement: A case report

2011 ◽  
Vol 139 (7-8) ◽  
pp. 531-535 ◽  
Author(s):  
Radmila Sparic ◽  
Gernot Hudelist ◽  
Joerg Keckstein
Keyword(s):  
Transvaginal Ultrasound ◽  
Laparoscopic Approach ◽  
Transvaginal Sonography ◽  
Deep Infiltrating Endometriosis ◽  
Deep Endometriosis ◽  
Fertility Sparing ◽  
Bowel Involvement ◽  
Surgical Teams ◽  
Histological Confirmation ◽  
Infiltrating Endometriosis

Introduction. Deep infiltrating endometriosis is a form of endometriosis penetrating deeply under the peritoneal surface causing pain and infertility. Assessment of the pelvis by laparoscopy and histological confirmation of the disease is considered the golden standard of diagnosis. Case Outline. We are presenting a patient diagnosed with deep infiltrating endometriosis by transvaginal ultrasound and treated with minimally invasive radical surgery including segmental resection of the bowel. Conclusion. Transvaginal sonography has an important role in detecting deep endometriosis of the pelvis. Fertility sparing surgery is the treatment of choice in symptomatic women wishing to retain fertility, since drugs used for endometriosis interfere with ovulation. The success of the surgery depends on the accuracy of the preoperative diagnosis. A multidisciplinary approach in managing deep endometriosis is mandatory in order to offer patients the best possible treatment using the combined skills of the colorectal and gynaecologic surgical teams. The presented case exhibits the feasibility of laparoscopic approach to severe pelvic endometriosis with bowel involvement.

scholarly journals LATE IMPACT OF THE LAPAROSCOPIC TREATMENT OF DEEP INFILTRATING ENDOMETRIOSIS WITH SEGMENTAL COLORECTAL RESECTION

2018 ◽  
Vol 31 (4) ◽  
Author(s):  
Antonio Matos ROCHA ◽  
Maurício Mendes de ALBUQUERQUE ◽  
Eduardo Miguel SCHMIDT ◽  
Cristiano Denoni FREITAS ◽  
João Paulo FARIAS ◽  
...  
Keyword(s):  
Colorectal Resection ◽  
Positive Impact ◽  
Therapeutic Option ◽  
Case Series ◽  
Laparoscopic Approach ◽  
Deep Infiltrating Endometriosis ◽  
Preoperative Period ◽  
Laparoscopic Treatment ◽  
Bowel Symptoms ◽  
Infiltrating Endometriosis

ABSTRACT Background: Deep infiltrating colorectal endometriosis may severely affect the quality of life and fertility of patients. Although segmental resection is a therapeutic option that provides positive outcomes in the management of symptoms, its functional effects are still unproven. Aim: Assess the late impact of the laparoscopic approach in treating deep infiltrating endometriosis with segmental colorectal resection. Methods: Prospective case series of 46 patients submitted to laparoscopic treatment of deep infiltrating endometriosis with segmental colorectal resection between 2013 and 2016. Fertility, gynecological and bowel symptoms were assessed at the preoperative period and at three and 12 months (or more) after the procedure. Results: Preoperative interview assessed the prevalence of infertility (45.6%), gynecological (87%) and intestinal (80.4%) symptoms. At the third month after the procedure a significant reduction in the prevalence of gynecological symptoms (p<0,001), tenesmus (p=0,001) and dysquesia (p=0,002) was observed. After a period of 12 months or more following the procedure a significant reduction in the prevalence persisted for dysmenorrhea (p=0,001), deep dyspareunia (p=0,041), chronic pelvic pain (p=0,011) and dysquesia (p=0,001), as compared to the preoperative period. Total pregnancy rate was 57.1% and spontaneous pregnancy 47.6%. Conclusion: The treatment of deep infiltrating endometriosis using segmental colorectal resection has provided early and late relief of gynecological and bowel symptoms. The outcomes also indicate a positive impact on the fertility of infertile patients.

Preserving Fertility by Treating the 3 Compartments: Laparoscopic Approach to Deep Infiltrating Endometriosis

2019 ◽  
Vol 26 (5) ◽  
pp. 804
Author(s):  
Virginie Collin ◽  
Marie Schaub ◽  
Emilie Faller ◽  
Christopher Burel ◽  
Guy Temporal ◽  
...  
Keyword(s):  
Laparoscopic Approach ◽  
Deep Infiltrating Endometriosis ◽  
Infiltrating Endometriosis

The Role of 3.0T MRI in the Assessment of Deep Endometriosis Located on the Uterosacral Ligaments

2013 ◽  
Vol 5 (1) ◽  
pp. 10-16 ◽  
Author(s):  
Lucia Manganaro ◽  
Valeria Vinci ◽  
Silvia Bernardo ◽  
Paola Storelli ◽  
Eliana Fuggetta ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Deep Infiltrating Endometriosis ◽  
Ovarian Endometriosis ◽  
Deep Endometriosis ◽  
Uterosacral Ligaments ◽  
3.0 T ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

Purpose To assess the diagnostic accuracy of 3.0T magnetic resonance imaging (MRI) in assessing the involvement of uterosacral ligaments (USLs) in deep infiltrating endometriosis (DIE). Methods Between July 2010 and July 2012, 42 women, aged between 19 and 45 years (mean age 28 years), with a diagnosis of cystic ovarian endometriosis and scheduled for laparoscopic treatment, underwent pre-operative 3.0-T MRI examination. USL was considered normal when it was not visible or when it was thin and regular. Results We found USL involvement in 20/42 cases: 4/20 had bilateral involvement, 16/20 had monolateral involvement; in the right ligament in 9/16 cases and in the left in 7/16. Asymmetric morphology was found in 17 patients with an arciform shape associated with increased thickness of the ligament. A thickness >3 mm was considered positive. These patients also presented thickening of the torus uterinus region. In three cases complete cul de sac obliteration led to loss of tissue plane which hindered identification of the USLs. Comparison with laparoscopy findings enabled us to achieve the following statistical values: 94.7% sensitivity, 91.3% specificity, 90.0% positive predictive value, 95.4% negative predictive value, and 93% diagnostic accuracy. Conclusions Optimal visualization of USLs was obtained on para-axial scans on T2W and T1W sequences which allowed an optimal anatomic visualization. In our study we demonstrated that 3.0T imaging enabled an optimal assessment of USL involvement to select patients for the correct kind of surgery or follow-up of these patients.

scholarly journals Spontaneous Healing of a Rectovaginal Fistula Developing after Laparoscopic Segmental Bowel Resection for Intestinal Deep Infiltrating Endometriosis

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
William Kondo ◽  
Reitan Ribeiro ◽  
Carlos Henrique Trippia ◽  
Monica Tessmann Zomer
Keyword(s):  
Rectovaginal Fistula ◽  
Bowel Resection ◽  
Intestinal Anastomosis ◽  
Pelvic Abscess ◽  
Deep Infiltrating Endometriosis ◽  
Laparoscopic Treatment ◽  
Spontaneous Healing ◽  
Uterosacral Ligaments ◽  
Segmental Bowel Resection ◽  
Infiltrating Endometriosis

The surgical treatment of intestinal deep infiltrating endometriosis has an associated risk of major complications such as dehiscence of the intestinal anastomosis, pelvic abscess, and rectovaginal fistula. The management of postoperative rectovaginal fistula frequently requires a reoperation and the construction of a stoma for temporary fecal diversion. In this paper we describe a 27-year-old woman undergoing laparoscopic treatment of deep infiltrating endometriosis (extramucosal cystectomy, resection of the uterosacral ligaments, resection of the posterior vaginal fornix, and segmental bowel resection) complicated by a rectovaginal fistula, which healed spontaneously with nonsurgical conservative treatment.

Hysteroscopic vaginoscopy. An additional diagnostic tool for recto-vaginal deep infiltrating endometriosis

2020 ◽  
pp. 228402652096786
Author(s):  
Brunella Zizolfi ◽  
Virginia Foreste ◽  
Attilio Di Spiezio Sardo ◽  
Pierluigi Giampaolino ◽  
Annarita Gencarelli ◽  
...  
Keyword(s):  
Bowel Resection ◽  
Uterine Cavity ◽  
Accurate Diagnosis ◽  
Endometrial Tissue ◽  
Deep Infiltrating Endometriosis ◽  
Resonance Imaging ◽  
Total Hysterectomy ◽  
Segmental Bowel Resection ◽  
History Of ◽  
Infiltrating Endometriosis

Endometriosis is the presence of endometrial tissue outside the uterine cavity. Rectovaginal infiltration is present in 5% to 25% of the patients diagnosed with endometriosis. Accurate diagnosis is imperative for adequate counseling. Hysteroscopic vaginoscopy allows the inspection of the posterior vaginal fornix, not only providing better visualization of the area due to image magnification, but also allowing to obtain biopsy providing pathologic confirmation. We report the case of a 49-year-old nulliparous patient with long history of severe dysmenorrhea, deep dyspareunia and debilitating chronic pelvic pain not responding to medical treatment. On physical exam, recto-vaginal tender nodularity was palpated. Vaginal ultrasound and magnetic resonance imaging confirmed the presence of the nodular formation extending up to the rectum. In-office vaginoscopy revealed a perforated bulge on the uterine cervix, mimicking a double cervix. A biopsy of the nodule confirmed the presence of endometrial tissue, confirming the diagnosis of endometriosis. Patient underwent total hysterectomy with excision of deep infiltrating endometriosis which required segmental bowel resection with diverting loop colostomy. The final pathology confirmed the diagnosis of deep infiltrating endometriosis.

Nerve fibers in uterosacral ligaments of women with deep infiltrating endometriosis

2008 ◽  
Vol 79 (1) ◽  
pp. 93-99 ◽  
Author(s):  
Adolpho Roberto Kelm ◽  
Carmen Lucia P Lancellotti ◽  
Nilson Donadio ◽  
Antonio Pedro F Auge ◽  
Sonia Maria Rolim R Lima ◽  
...  
Keyword(s):  
Nerve Fibers ◽  
Deep Infiltrating Endometriosis ◽  
Uterosacral Ligaments ◽  
Infiltrating Endometriosis
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