Laparoscopic treatment of deep endometriosis located on the uterosacral ligaments

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 increases pregnancy rate in infertile patients

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2016.07.360 ◽

2016 ◽

Vol 206 ◽

pp. e142

Author(s):

Centini Gabriele ◽

Lazzeri Lucia ◽

Antonella Biscione ◽

Afors Karolina ◽

Wattiez Arnaud ◽

...

Keyword(s):

Pregnancy Rate ◽

Laparoscopic Treatment ◽

Deep Endometriosis ◽

Infertile Patients

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

Case Reports in Obstetrics and Gynecology ◽

10.1155/2013/837903 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 1

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.

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Laparoscopic Treatment of Deep Endometriosis with Segmental Colorectal Resection: Short-Term Morbidity

Journal of Minimally Invasive Gynecology ◽

10.1016/j.jmig.2008.09.267 ◽

2008 ◽

Vol 15 (6) ◽

pp. 69S

Author(s):

A. Fiaccavento ◽

L. Mereu ◽

G. Ruffo ◽

S. Landi ◽

F. Barbieri ◽

...

Keyword(s):

Colorectal Resection ◽

Laparoscopic Treatment ◽

Short Term ◽

Deep Endometriosis

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Laparoscopic treatment of tubo-ovarian abscess with deep endometriosis, a case report

JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY ◽

10.5180/jsgoe.29.88 ◽

2013 ◽

Vol 29 (1) ◽

pp. 88-93

Author(s):

Reiko Takeuchi ◽

Motofumi Yokoyama ◽

Chihiro Minami ◽

Nobutaka Hachisuga ◽

Nobuko Yasutake ◽

...

Keyword(s):

Case Report ◽

Laparoscopic Treatment ◽

Deep Endometriosis ◽

Ovarian Abscess

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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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