Does deep endometriosis infiltrating the uterosacral ligaments present an asymmetric lateral distribution?

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.

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Laparoscopic treatment of deep endometriosis located on the uterosacral ligaments

Human Reproduction ◽

10.1093/oxfordjournals.humrep.a019268 ◽

1996 ◽

Vol 11 (4) ◽

pp. 868-873 ◽

Cited By ~ 59

Author(s):

C. Chapron ◽

J.-B. Dubuisson

Keyword(s):

Laparoscopic Treatment ◽

Deep Endometriosis ◽

Uterosacral Ligaments

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VP05.17: Learning curve for the ultrasound detection of uterosacral ligaments and torus uterinus deep endometriosis: repeatability and reproducibility study

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.24102 ◽

2021 ◽

Vol 58 (S1) ◽

pp. 116-116

Author(s):

R.M. Rocha ◽

J.V. Zanardi ◽

G. Condous

Keyword(s):

Learning Curve ◽

Deep Endometriosis ◽

Reproducibility Study ◽

Uterosacral Ligaments ◽

Repeatability And Reproducibility

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

BioMed Research International ◽

10.1155/2016/3617179 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 69

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.

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Ultrasound in the Diagnosis of Deep Endometriosis

Donald School Journal of Ultrasound in Obstetrics & Gynecology ◽

10.5005/jp-journals-10009-1004 ◽

2009 ◽

Vol 3 (1) ◽

pp. 15-20 ◽

Cited By ~ 1

Author(s):

Silvia Ajossa ◽

Anna Maria Paoletti ◽

Nicoletta Garau ◽

Valerio Mais ◽

Bruno Piras ◽

...

Keyword(s):

Gold Standard ◽

Low Cost ◽

Transvaginal Ultrasonography ◽

Rectovaginal Septum ◽

Specific Training ◽

First Line ◽

Deep Endometriosis ◽

Uterosacral Ligaments ◽

Diagnostic Capability ◽

Bladder Endometriosis

Abstract Deep pelvic endometriosis is defined as subperitoneal infiltration of endometrial implants in the uterosacral ligaments, rectum, rectovaginal septum, vagina, or bladder. Although laparoscopy and biopsy remain the gold standard for diagnosis, transvaginal ultrasonography should be considered as the first-line procedure because of its high diffusion and relatively low cost and discomfort. We analyzed in the present review the diagnostic capability of transvaginal ultrasonography in the detection of presence of deep endometriosis in some specific pelvic localizations such as bowel, uterosacral ligaments, rectovaginal septum and/or vagina. We also analyzed the few studies performed in the evaluation of bladder endometriosis. Although some studies are controversial, transvaginal ultrasonography seems to be an accurate technique in the identifications of deep endometriosis in several pelvic locations but a specific training of the operators is suggested.

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Recommendations for the surgical treatment of endometriosis. Part 2: deep endometriosis †‡¶

Human Reproduction Open ◽

10.1093/hropen/hoaa002 ◽

2020 ◽

Vol 2020 (1) ◽

Cited By ~ 15

Author(s):

◽

Joerg Keckstein ◽

Christian M Becker ◽

Michel Canis ◽

Anis Feki ◽

...

Keyword(s):

Surgical Treatment ◽

Working Group ◽

Financial Support ◽

Technical Information ◽

Reproductive Age ◽

Clinical Expertise ◽

Deep Endometriosis ◽

Uterosacral Ligaments ◽

Competing Interest ◽

Extrapelvic Endometriosis

Abstract STUDY QUESTION How should surgery for endometriosis be performed? SUMMARY ANSWER This document provides recommendations covering technical aspects of different methods of surgery for deep endometriosis in women of reproductive age. WHAT IS KNOWN ALREADY Endometriosis is highly prevalent and often associated with severe symptoms. Yet compared to equally prevalent conditions, it is poorly understood and a challenge to manage. Previously published guidelines have provided recommendations for (surgical) treatment of deep endometriosis, based on the best available evidence, but without technical information and details on how to best perform such treatment in order to be effective and safe. STUDY DESIGN, SIZE, DURATION A working group of the European Society for Gynaecological Endoscopy (ESGE), ESHRE and the World Endometriosis Society (WES) collaborated on writing recommendations on the practical aspects of surgery for treatment of deep endometriosis. PARTICIPANTS/MATERIALS, SETTING, METHODS This document focused on surgery for deep endometriosis and is complementary to a previous document in this series focusing on endometrioma surgery. MAIN RESULTS AND THE ROLE OF CHANCE The document presents general recommendations for surgery for deep endometriosis, starting from preoperative assessments and first steps of surgery. Different approaches for surgical treatment are discussed and are respective of location and extent of disease; uterosacral ligaments and rectovaginal septum with or without involvement of the rectum, urinary tract or extrapelvic endometriosis. In addition, recommendations are provided on the treatment of frozen pelvis and on hysterectomy as a treatment for deep endometriosis. LIMITATIONS, REASONS FOR CAUTION Owing to the limited evidence available, recommendations are mostly based on clinical expertise. Where available, references of relevant studies were added. WIDER IMPLICATIONS OF THE FINDINGS These recommendations complement previous guidelines on management of endometriosis and the recommendations for surgical treatment of ovarian endometrioma. STUDY FUNDING/COMPETING INTEREST(S) The meetings of the working group were funded by ESGE, ESHRE and WES. Dr Roman reports personal fees from ETHICON, PLASMASURGICAL, OLYMPUS and NORDIC PHARMA, outside the submitted work; Dr Becker reports grants from Bayer AG, Volition Rx, MDNA Life Sciences and Roche Diagnostics Inc. and other relationships or activities from AbbVie Inc., and Myriad Inc, during the conduct of the study; Dr Tomassetti reports non-financial support from ESHRE, during the conduct of the study; and non-financial support and other were from Lumenis, Gedeon-Richter, Ferring Pharmaceuticals and Merck SA, outside the submitted work. The other authors had nothing to disclose. TRIAL REGISTRATION NUMBER na

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