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Carfagna P, De Cicco Nardone A, Benvenga G, Nardone FDC, Greco P, Campolo F, Pafundi PC, Alesi MV, Testa AC, Scambia G, Ianieri MM. Preoperative diagnosis of ureteral medial deviations secondary to deep endometriosis using transvaginal ultrasound examinations: Can we predict the need for ureterolysis during laparoscopic surgery? Int J Gynaecol Obstet 2024; 166:663-671. [PMID: 38404039 DOI: 10.1002/ijgo.15434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/18/2024] [Accepted: 02/04/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE To evaluate ureteral involvement using transvaginal sonography (TVS) regarding the distortion of the course of the ureters caused by deep endometriosis (DE), which can facilitate predicting the need for ureterolysis during surgery, even in the absence of ureteral stenosis or dilatation. METHODS This is a single-center, observational, retrospective pilot study of 88 consecutive patients who later underwent surgery for DE that used ultrasound preoperative diagnosis of ureteral medial deviation of one or both ureters between January 2019 and January 2022. At TVS, the course of the ureter was considered medialized if, in longitudinal and transversal section, any distance was detectable between the ureter and the cervix at the point where the ureter crosses the uterine artery. The primary end point was to determine sensitivity, specificity, and positive and negative predictive values of "ureteral medial deviation" diagnosed using TVS, in order to predict the need for ureterolysis. RESULTS Our series included 88 women with a median age of 39 (interquartile range 33-43) years. Ureteral medialization showed a relatively low false-positive rate (10.9%), with a specificity of 89.1% (95% confidence interval [CI] 81.4%-96.7%) and a sensitivity of 86.6% (95% CI 80.3%-92.9%), along with a high positive predictive value of 93.3% (95% CI 88.4%-98.1%), and a lower negative predictive value of 79.1% (95% CI 69.8%-88.5%), respectively. CONCLUSIONS This study introduced a new ultrasound sign with a high degree of accuracy to predict ureterolysis and this may have positive implications in the management and surgical planning of patients with ureteral endometriosis.
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Affiliation(s)
- Pietro Carfagna
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Alessandra De Cicco Nardone
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Greta Benvenga
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Fiorenzo De Cicco Nardone
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | | | - Federica Campolo
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Pia Clara Pafundi
- Faculty of Epidemiology and Biostatistics-GEMELLI GENERATOR, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Antonia Carla Testa
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Manuel Maria Ianieri
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
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Ianieri MM, Alesi MV, Querleu D, Ercoli A, Chiantera V, Carcagnì A, Campolo F, Greco P, Scambia G. Anatomical-based classification of dorsolateral parametrectomy for deep endometriosis. Correlation with surgical complications and functional outcomes: A single- center prospective study. Int J Gynaecol Obstet 2024. [PMID: 39031095 DOI: 10.1002/ijgo.15781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/28/2024] [Accepted: 07/02/2024] [Indexed: 07/22/2024]
Abstract
OBJECTIVE To evaluate complication rate and functional outcomes of nerve-sparing parametrectomy for deep endometriosis in relation to the extension of the surgical procedure, based on recognizable anatomical landmarks. METHODS This was a prospective single-center study including all patients undergoing parametrectomy for deep endometriosis from September 2020 to June 2023 at our tertiary center. Dorsolateral parametrectomies were divided into parametrectomies medial to the presacral fascia and cranial to the medial rectal artery (superficial parametrectomy), and parametrectomies in which one of the two landmarks was overcome during the surgical procedure, leading to the excision of tissue lateral to the presacral fascia (deep parametrectomy type 1, or DP1) or caudal to the medial rectal artery (DP2). Finally, we used the hypogastric fascia as landmark to define type 3 deep parametrectomy (DP3), when the procedure was deeply lateral to the fascia. RESULTS Bladder voiding deficit occurred in 9.7% of cases, with higher rates in DP2 (20.8%) and DP3 (30%) groups. Regarding postoperative gastrointestinal function, our data showed a significant improvement over time in all groups, with the exception of DP2; instead an improvement in postoperative bladder function was only shown in DP3. Parametrectomy was not associated with a simultaneous improvement in sexual function expressed with the female sexual function index, in any of the four groups. CONCLUSION Our classification constitutes a concrete approach for comparing, in a standardized way, the complications and functional outcomes of parametrectomy, which, even if carried out by expert surgeons, demonstrates a non-negligible rate of bladder voiding deficit.
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Affiliation(s)
- Manuel Maria Ianieri
- Unit of Oncological Gynecology, Women's Children's and Public Health Department, IRCCS, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - Maria Vittoria Alesi
- Unit of Oncological Gynecology, Women's Children's and Public Health Department, IRCCS, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Denis Querleu
- Unit of Oncological Gynecology, Women's Children's and Public Health Department, IRCCS, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Alfredo Ercoli
- Department of Human Pathology of the Adult and Child "Gaetano Barresi", University of Messina, Messina, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, National Cancer Institute - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Antonella Carcagnì
- Epidemiology and Biostatistics Research Core Facility, Gemelli Generator, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Federica Campolo
- Unit of Oncological Gynecology, Women's Children's and Public Health Department, IRCCS, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Pierfrancesco Greco
- Unit of Oncological Gynecology, Women's Children's and Public Health Department, IRCCS, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Giovanni Scambia
- Unit of Oncological Gynecology, Women's Children's and Public Health Department, IRCCS, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
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Ottolina J, Villanacci R, D’Alessandro S, He X, Grisafi G, Ferrari SM, Candiani M. Endometriosis and Adenomyosis: Modern Concepts of Their Clinical Outcomes, Treatment, and Management. J Clin Med 2024; 13:3996. [PMID: 39064036 PMCID: PMC11277467 DOI: 10.3390/jcm13143996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024] Open
Abstract
Endometriosis and adenomyosis are complex gynecological conditions characterized by diverse clinical presentations, including superficial peritoneal endometriosis (SPE), ovarian endometrioma (OMA), and deep infiltrating endometriosis (DIE). The hallmark features of these pathologies involve the manifestation of pain symptoms and infertility, and approximately 30% of patients are asymptomatic. Despite ongoing research, definitive treatments for these conditions remain elusive, and clinical management primarily revolves around medical or surgical interventions. Recent advancements in our understanding of the efficacy of various treatment modalities, including medical therapy and surgical interventions, have provided clinicians with valuable insights into pain relief and fertility preservation. This review aims to provide an updated overview of the latest literature on clinical outcomes, treatment options, and management strategies for different types of endometriosis. By synthesizing the newest available data, this review seeks to inform clinicians and guide decision making based on factors such as patients' symptom severity, childbearing desire, and overall health.
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Affiliation(s)
- Jessica Ottolina
- IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (R.V.); (S.D.); (G.G.); (S.M.F.); (M.C.)
| | - Roberta Villanacci
- IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (R.V.); (S.D.); (G.G.); (S.M.F.); (M.C.)
| | - Sara D’Alessandro
- IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (R.V.); (S.D.); (G.G.); (S.M.F.); (M.C.)
| | - Xuemin He
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of “Aldo Moro”, 70124 Bari, Italy;
| | - Giorgia Grisafi
- IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (R.V.); (S.D.); (G.G.); (S.M.F.); (M.C.)
| | - Stefano Maria Ferrari
- IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (R.V.); (S.D.); (G.G.); (S.M.F.); (M.C.)
| | - Massimo Candiani
- IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (R.V.); (S.D.); (G.G.); (S.M.F.); (M.C.)
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Chatroux LR, Einarsson JI. Keep your attention closer to the ureters: Ureterolysis in deep endometriosis surgery. Best Pract Res Clin Obstet Gynaecol 2024; 95:102494. [PMID: 38614884 DOI: 10.1016/j.bpobgyn.2024.102494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/15/2024] [Accepted: 03/11/2024] [Indexed: 04/15/2024]
Abstract
Endometriosis surgery involving the ureter poses significant challenges requiring meticulous surgical techniques and vigilant postoperative care. This chapter addresses key aspects of ureterolysis techniques, intraoperative management of ureteral injuries, and postoperative care in the context of endometriosis surgery. Ureterolysis methods aim to isolate and mobilize the ureter while preserving its vascularity. Cold instruments and careful dissection are recommended to prevent thermal injury during surgery. Intraoperative tools such as indocyanine green (ICG) show promise in assessing for vascular compromise. Over half of ureteral injuries are detected postoperatively, necessitating a high index of suspicion. Optimal postoperative care in the case of ureteral injury involves Foley catheterization for decompression, ureteral stenting, and meticulous follow-ups to monitor healing and renal function. While advances have been made in surgical techniques and diagnostic tools, gaps persist in preoperative imaging optimization and predictive models for identifying at-risk patients. This chapter aims to bridge existing knowledge gaps, optimize surgical practices, and enhance the overall care and outcomes of patients undergoing endometriosis surgery involving the ureter.
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Affiliation(s)
- Louisa R Chatroux
- Brigham & Women's Hospital, Department of Obstetrics, Gynecology, and Reproductive Biology Division of Minimally Invasive Gynecologic Surgery, Harvard Medical School, Boston, MA, USA.
| | - Jon I Einarsson
- Brigham & Women's Hospital, Department of Obstetrics, Gynecology, and Reproductive Biology Division of Minimally Invasive Gynecologic Surgery, Harvard Medical School, Boston, MA, USA
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5
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Choi S, Roviglione G, Chou D, D'Ancona G, Ceccaroni M. Nerve-sparing surgery in deep endometriosis: Has its time come? Best Pract Res Clin Obstet Gynaecol 2024:102506. [PMID: 38981835 DOI: 10.1016/j.bpobgyn.2024.102506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 05/05/2024] [Accepted: 05/19/2024] [Indexed: 07/11/2024]
Abstract
Nerve-sparing (NS) surgery was first introduced for the treatment of deep endometriosis (DE) 20 years ago, drawing on established neuroanatomy and success from oncological applications. It aims to identify and preserve autonomic nerve fibres, reduce iatrogenic nerve injury, and minimize postoperative visceral dysfunction, without compromising the therapeutic effectiveness against endometriosis. The evolution of NS surgical techniques over the past two decades has been supported by an expanding body of literature on anatomical details, dissection techniques, and functional outcomes. Recent evidence suggests that NS surgery results in reduced postoperative voiding dysfunction (POVD). Transient POVD may be influenced by preoperative dysfunction, with parametrial infiltration being a strong predictive factor for POVD. While the benefits in bowel and sexual functions are less pronounced and consistent, NS surgery potentially prevents de novo dysfunctions in these areas. Furthermore, perioperative complication rates, effectiveness in pain relief, and fertility outcomes are reportedly on par with conventional surgery.
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Affiliation(s)
- Sarah Choi
- Sydney Women's Endosurgery Centre, Women's & Children's Health, St. George Hospital, South Eastern Sydney Local Health District, New South Wales, 2217, Australia.
| | - Giovanni Roviglione
- Department of Obstetrics and Gynaecology, Gynaecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS Sacro-Cuore - Don Calabria Hospital, Via Don A. Sempreboni 5, Negrar, Verona, Italy.
| | - Danny Chou
- Sydney Women's Endosurgery Centre, Women's & Children's Health, St. George Hospital, South Eastern Sydney Local Health District, New South Wales, 2217, Australia; Division of Obstetrics and Gynaecology, School of Clinical Medicine, Health and Medicine, University of New South Wales, Sydney, New South Wales, 2052, Australia.
| | - Gianmarco D'Ancona
- Department of Obstetrics and Gynaecology, Gynaecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS Sacro-Cuore - Don Calabria Hospital, Via Don A. Sempreboni 5, Negrar, Verona, Italy.
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynaecology, Gynaecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS Sacro-Cuore - Don Calabria Hospital, Via Don A. Sempreboni 5, Negrar, Verona, Italy.
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Barra F, Ferrero S, Zorzi C, Evangelisti G, Perrone U, Valente I, Capezzuoli T, D'Ancona G, Bogliolo S, Roviglione G, Ceccaroni M. "From the tip to the deep of the iceberg": Parametrial involvement in endometriosis. Best Pract Res Clin Obstet Gynaecol 2024; 94:102493. [PMID: 38581882 DOI: 10.1016/j.bpobgyn.2024.102493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 03/19/2024] [Accepted: 03/23/2024] [Indexed: 04/08/2024]
Abstract
Deep endometriosis (DE) can be localized in the parametrium, a complex bilateral anatomical structure, sometimes necessitating intricate surgical intervention due to the potential involvement of autonomic nerves, uterine artery, and ureter. If endometriotic ovarian cysts have been considered metaphorically representative of "the tip of the iceberg" concerning concealed DE lesions, it is reasonable to assert that parametrial lesions should be construed as the most profound region of this iceberg. Also, based on a subdual clinical presentation, a comprehensive diagnostic parametrial evaluation becomes imperative to strategize optimal management for patients with suspected DE. Recently, the ULTRAPARAMETRENDO studies aimed to evaluate the role of transvaginal ultrasound for parametrial endometriosis, showing distinctive features, such as a mild hypoechoic appearance, starry morphology, irregular margins, and limited vascularization. The impact of medical therapy on parametrial lesions has not been described in the current literature, primarily due to the lack of adequate detection at imaging. The extension of DE into the parametrium poses significant challenges during the surgical approach, thereby increasing the risk of intra- and postoperative complications, mainly if performed by centers with low expertise and following multiple surgical procedures where parametrial involvement has gone unrecognized. Over time, the principles of nerve-sparing surgery have been incorporated into the surgical DE treatment to minimize iatrogenic damage and potentially reduce the risk of functional complications.
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Affiliation(s)
- Fabio Barra
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni 5, Negrar, 37024, Verona, Italy; Unit of Obstetrics and Gynecology, P.O. "Ospedale Del Tigullio"-ASL4, Via Gio Batta Ghio 9, Chiavari, 16043, Genoa, Italy.
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy
| | - Carlotta Zorzi
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni 5, Negrar, 37024, Verona, Italy
| | - Giulio Evangelisti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy; Unit of Obstetrics and Gynecology, San Paolo Hospital - ASL2, Savona, 17100, Italy
| | - Umberto Perrone
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy
| | - Irene Valente
- Unit of Radiology, P.O. "Ospedale del Tigullio"-ASL4, Via Gio Batta Ghio 9, Chiavari, 16043, Genoa, Italy
| | - Tommaso Capezzuoli
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni 5, Negrar, 37024, Verona, Italy
| | - Gianmarco D'Ancona
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni 5, Negrar, 37024, Verona, Italy
| | - Stefano Bogliolo
- Unit of Obstetrics and Gynecology, P.O. "Ospedale Del Tigullio"-ASL4, Via Gio Batta Ghio 9, Chiavari, 16043, Genoa, Italy
| | - Giovanni Roviglione
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni 5, Negrar, 37024, Verona, Italy
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni 5, Negrar, 37024, Verona, Italy
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Ianieri MM, De Cicco Nardone A, Greco P, Carcagnì A, Campolo F, Pacelli F, Scambia G, Santullo F. Totally intracorporeal colorectal anastomosis (TICA) versus classical mini-laparotomy for specimen extraction, after segmental bowel resection for deep endometriosis: a single-center experience. Arch Gynecol Obstet 2024; 309:2697-2707. [PMID: 38512463 PMCID: PMC11147928 DOI: 10.1007/s00404-024-07412-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/01/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE The surgical approach to bowel endometriosis is still unclear. The aim of the study is to compare TICA to conventional specimen extractions and extra-abdominal insertion of the anvil in terms of both complications and functional outcomes. METHODS This is a single-center, observational, retrospective study conducted enrolling symptomatic women underwent laparoscopic excision of deep endometriosis with segmental bowel resection between September 2019 and June 2022. Women who underwent TICA were compared to classical technique (CT) in terms of intra- and postoperative complications, moreover, functional outcomes relating to the pelvic organs were assessed using validated questionnaires [Knowles-Eccersley-Scott-Symptom (KESS) questionnaire and Gastro-Intestinal Quality of Life Index (GIQLI)] for bowel function. Pain symptoms were assessed using Visual Analogue Scale (VAS) scores. RESULTS The sample included 64 women. TICA was performed on 31.2% (n = 20) of the women, whereas CT was used on 68.8% (n = 44). None of the patients experienced rectovaginal, vesicovaginal, ureteral or vesical fistula, or ureteral stenosis and uroperitoneum, and in no cases was it necessary to reoperate. Regarding the two surgical approaches, no significant difference was observed in terms of complications. As concerns pain symptoms at 6-month follow-up evaluations on stratified data, except for dysuria, all VAS scales reported showed significant reductions between median values, for both surgery interventions. As well, significant improvements were further observed in KESS scores and overall GIQLI. Only the GIQLI evaluation was significantly smaller in the TICA group compared to CT after the 6-month follow-up. CONCLUSIONS We did not find any significant differences in terms of intra- or post-operative complications compared TICA and CT, but only a slight improvement in the Gastro-Intestinal Quality of Life Index in patients who underwent the CT compared to the TICA technique.
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Affiliation(s)
- Manuel Maria Ianieri
- Unit of Oncological Gynecology, Women's Children's and Public Health Department, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - Alessandra De Cicco Nardone
- Unit of Oncological Gynecology, Women's Children's and Public Health Department, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | - Antonella Carcagnì
- Catholic University of the Sacred Heart, Rome, Italy
- Epidemiology and Biostatistics Research Core Facility, Gemelli Generator, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Federica Campolo
- Unit of Oncological Gynecology, Women's Children's and Public Health Department, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Fabio Pacelli
- Catholic University of the Sacred Heart, Rome, Italy
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Scambia
- Unit of Oncological Gynecology, Women's Children's and Public Health Department, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Santullo
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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8
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Pavone M, Baroni A, Campolo F, Goglia M, Raimondo D, Carcagnì A, Akladios C, Marescaux J, Fanfani F, Scambia G, Ianieri MM. Robotic assisted versus laparoscopic surgery for deep endometriosis: a meta-analysis of current evidence. J Robot Surg 2024; 18:212. [PMID: 38753180 PMCID: PMC11098866 DOI: 10.1007/s11701-024-01954-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/14/2024] [Indexed: 05/19/2024]
Abstract
Endometriosis is a benign inflammatory onco-mimetic disease affecting 10-15% of women in the world. When it is refractory to medical treatments, surgery may be required. Usually, laparoscopy is the preferred approach, but robotic surgery has gained popularity in the last 15 years. This study aims to evaluate the safety and efficacy of robotic-assisted laparoscopic surgery (RAS) versus conventional laparoscopic surgery (LPS) in the treatment of endometriosis. This study adheres to PRISMA guidelines and is registered with PROSPERO. Studies reporting perioperative data comparing RAS and LPS surgery in patients with endometriosis querying PubMed, Google Scholar and ClinicalTrials.gov were included in the analysis. The Quality Assessment of Diagnostic Accuracy Studies 2 tool (QUADAS-2) was used for the quality assessment of the selected articles. Fourteen studies were identified, including 2709 patients with endometriosis stage I-IV for the meta-analysis. There were no significant differences between RAS and LPS in terms of intraoperative and postoperative complications, conversion rate and estimated blood loss. However, patients in the RAS group have a longer operative time (p < 0.0001) and longer hospital stay (p = 0.020) than those in the laparoscopic group. Robotic surgery is not inferior to laparoscopy in patients with endometriosis in terms of surgical outcomes; however, RAS requires longer operative times and longer hospital stay. The benefits of robotic surgery should be sought in the easiest potential integration of robotic platforms with new technologies. Prospective studies comparing laparoscopy to the new robotic systems are desirable for greater robustness of scientific evidence.
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Affiliation(s)
- Matteo Pavone
- UOC Ginecologia Oncologica, Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France.
- Research Institute against Digestive Cancer, IRCAD, Strasbourg, France.
| | - Alessandro Baroni
- UOC Ginecologia Oncologica, Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Federica Campolo
- UOC Ginecologia Oncologica, Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Marta Goglia
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Diego Raimondo
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonella Carcagnì
- Facility of Epidemiology and Biostatistics - Gemelli Generator, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Cherif Akladios
- Department of Gynecologic Surgery, University Hospitals of Strasbourg, Strasbourg, France
| | - Jacques Marescaux
- Research Institute against Digestive Cancer, IRCAD, Strasbourg, France
| | - Francesco Fanfani
- UOC Ginecologia Oncologica, Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Manuel Maria Ianieri
- UOC Ginecologia Oncologica, Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
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9
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Oppenheimer A, Boitrelle F, Nicolas‐Boluda A, Fauconnier A. Measurement properties of sexual function assessment questionnaires in women with endometriosis: A systematic review following COSMIN guidelines. Acta Obstet Gynecol Scand 2024; 103:799-823. [PMID: 38226426 PMCID: PMC11019533 DOI: 10.1111/aogs.14768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 01/17/2024]
Abstract
INTRODUCTION Sexual function of patients with endometriosis should be assessed by patient-reported outcome measures (PROMs) that present high reliability and validity. The objective was to study the PROMs used to assess sexual function for patients with endometriosis to improve their selection for research and clinical practice. MATERIAL AND METHODS We performed a systematic literature review from January 2000 to September 2023. All studies including women with confirmed endometriosis and assessing sexual quality of life or sexual function or sexual distress were retrieved. Different properties of PROMs used for sexual dysfunction were assessed according to the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) recommendations. Properties evaluated were: structural validity, internal consistency, cross-cultural validity, reliability, measurement error, criterion validity, construct validity, and responsiveness. This literature review was registered on Prospero as 2018 CRD42018102278. RESULTS Seventy-four articles with evaluation of sexual function were included. Of the 25 PROMs assessing sexual function, the Female Sexual Function Index (FSFI) was the most frequently used (34/74 [45.9%] items), followed by the Female Sexual Distress Scale (9/74 [12.2%] items) and the Sexual Activity Questionnaire (SAQ) (8/74 [10.8%] items). The most commonly used measurement properties were "hypothesis testing" and "responsiveness". The PROMs with a high level of evidence for these two measurement properties were the FSFI, the SAQ, the Short Sexual Functioning Scale, the Sexual Satisfaction Scale for Women, Sexual Quality of Life-Female, the Brief Profile of Female Sexual Function, and the Sexual Health Outcomes in Women Questionnaire. The FSFI questionnaire appeared to be more relevant for evaluating medical treatment, and the SAQ for evaluating surgical treatment. Only one instrument was specific to endometriosis (the Subjective Impact of Dyspareunia Inventory [SIDI]). CONCLUSIONS In this systematic literature review of sexual function assessment questionnaires in endometriosis, the FSFI and the SAQ questionnaires emerged as having the best measurement properties according to the COSMIN criteria. The FSFI questionnaire appears to be suited for evaluating medical treatment, and the SAQ for surgical treatment. The SIDI is the only specific questionnaire, but its responsiveness remains to be defined.
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Affiliation(s)
- Anne Oppenheimer
- EA 7285 Research Unit “Risk and Safety in Clinical Medicine for Women and Perinatal Health”Versailles‐Saint‐Quentin University (UVSQ)Montigny‐le‐BretonneuxFrance
- Department of Reproductive Medicine and Fertility PreservationUniversity hospital Antoine BéclèreClamartFrance
- Department of Reproductive MedicineClinique de La MuetteParisFrance
| | - Florence Boitrelle
- Department of Reproductive Biology, Fertility Preservation, Andrology and CECOSPoissy HospitalPoissyFrance
- Department BREED, UVSQ, INRAEParis Saclay UniversityJouy‐en‐JosasFrance
| | | | - Arnaud Fauconnier
- Department of Reproductive Medicine and Fertility PreservationUniversity hospital Antoine BéclèreClamartFrance
- Centre Hospitalier Intercommunal de Poissy‐Saint‐Germain‐en‐LayeDepartment of Gynecology and ObstetricsPoissyFrance
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10
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Moro F, Ianieri MM, De Cicco Nardone A, Carfagna P, Mascilini F, Vizzielli G, Biasioli A, Pontrelli G, Virgilio BA, Ladisa I, Carlea A, Lo Turco A, Beneduce G, Arcieri M, Scaglione G, Fanfani F, Scambia G, Testa AC. Comparison of clinical and ultrasound examinations in assessing the parametria in patients with deep infiltrating endometriosis: a multicentre prospective study. Reprod Biomed Online 2024; 48:103733. [PMID: 38401251 DOI: 10.1016/j.rbmo.2023.103733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/11/2023] [Accepted: 11/17/2023] [Indexed: 02/26/2024]
Abstract
RESEARCH QUESTION How do clinical rectovaginal examination and transvaginal ultrasound examination perform in the diagnosis of parametrial infiltration in patients with endometriosis? DESIGN This was a multicentre prospective observational study. Patients with suspected deep endometriosis at clinical examination and/or at ultrasound evaluation and scheduled for surgery were included. Following multicentre multidisciplinary meetings, consensus was obtained on terms and methodology to define the parametrium at pelvic anatomy, ultrasound and surgery. Sensitivity, specificity, accuracy, and positive and negative likelihood ratios were calculated for clinical and ultrasound examinations with respect to surgery. RESULTS In total, 195 women were selected for the present study and 164 were included in the analysis. Ultrasound examination had good to high specificity (>80%) for all parameters, except the left lateral parametrium (78.8%). The sensitivity of ultrasound examination was good to high for fixity of the right and left ovaries, uterosacral ligaments, retrocervix and rectovaginal space; and low for the anterior and lateral parametria, vagina, bladder and bowel. Clinical examination had good to high specificity for fixity of the left ovary, anterior parametrium, right uterosacral ligament, retrocervix and vagina; and low specificity for fixity of the right ovary, lateral parametrium, left uterosacral ligament and rectovaginal space. The sensitivity of clinical examination was good for the uterosacral ligaments and rectovaginal space, and low for the remaining parameters. CONCLUSION Ultrasound examination provided good specificity for all the parameters, but sensitivity was low for the anterior and lateral parametria. Clinical examination provided good specificity for the anterior and posterior parametria, but sensitivity was low for the anterior and lateral parametria. Further prospective studies are needed to validate this methodology and confirm the results.
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Affiliation(s)
- Francesca Moro
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy.
| | - Manuel Maria Ianieri
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Alessandra De Cicco Nardone
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Pietro Carfagna
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Floriana Mascilini
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Giuseppe Vizzielli
- Department of Maternal and Child Health, Obstetrics and Gynaecology Clinic, University Hospital of Udine, Udine, Italy; Department of Medical Area, University of Udine, Udine, Italy
| | - Anna Biasioli
- Department of Medical Area, University of Udine, Udine, Italy
| | - Giovanni Pontrelli
- Department of Obstetrics and Gynaecology, Policlinico of Abano Terme, Abano Terme, Italy
| | - Bruna Anna Virgilio
- Department of Obstetrics and Gynaecology, Policlinico of Abano Terme, Abano Terme, Italy
| | - Irene Ladisa
- Università Cattolica del Sacro Cuore, Istituto di Clinica Ostetrica e Ginecologica, Rome, Italy
| | - Annunziata Carlea
- Università Cattolica del Sacro Cuore, Istituto di Clinica Ostetrica e Ginecologica, Rome, Italy
| | - Alice Lo Turco
- Università Cattolica del Sacro Cuore, Istituto di Clinica Ostetrica e Ginecologica, Rome, Italy
| | - Giuliana Beneduce
- Università Cattolica del Sacro Cuore, Istituto di Clinica Ostetrica e Ginecologica, Rome, Italy
| | - Martina Arcieri
- Clinic of Obstetrics and Gynaecology, 'Santa Maria della Misericordia' University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy; Department of Biomedical, Dental, Morphological and Functional Imaging Science, University of Messina, Messina, Italy
| | - Giulia Scaglione
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Francesco Fanfani
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy; Università Cattolica del Sacro Cuore, Istituto di Clinica Ostetrica e Ginecologica, Rome, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy; Università Cattolica del Sacro Cuore, Istituto di Clinica Ostetrica e Ginecologica, Rome, Italy
| | - Antonia Carla Testa
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy; Università Cattolica del Sacro Cuore, Istituto di Clinica Ostetrica e Ginecologica, Rome, Italy
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11
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Centini G, Labanca L, Giorgi M, Martire FG, Catania F, Zupi E, Lazzeri L. The implications of the anatomy of the nerves and vessels in the treatment of rectosigmoid endometriosis. Clin Anat 2024; 37:270-277. [PMID: 37165994 DOI: 10.1002/ca.24059] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 04/30/2023] [Accepted: 05/02/2023] [Indexed: 05/12/2023]
Abstract
Endometriosis is a common benign gynecological disease characterized by the presence of endometrial glands and stroma outside the uterus. It can be defined as endometrioma, superficial peritoneal endometriosis or deep infiltrating endometriosis (DIE) depending on the location and the depth of infiltration of the organs. In 5%-12% of cases, DIE affects the digestive tract, frequently involving the distal part of the sigmoid colon and rectum. Surgery is generally recommended in cases of obstructive symptoms and in cases with pain that is non-responsive to medical treatment. Selection of the most optimal surgical technique for the treatment of bowel endometriosis must consider different variables, including the number of lesions, eventual multifocal lesions, as well as length, width and grade of infiltration into the bowel wall. Except for some major and widely accepted indications regarding bowel resection, established international guidelines are not clear on when to employ a more conservative approach like rectal shaving or discoid resection, and when, instead, to opt for bowel resection. Damage to the pelvic autonomic nervous system may be avoided by detection of the middle rectal artery, where its relationship with female pelvic nerve fibers allows its use as an anatomical landmark. To reduce the risk of potential vascular and nervous complications related to bowel resection, a less invasive approach such as shaving or discoid resection can be considered as potential treatment options. Additionally, the middle rectal artery can be used as a reference point in cases of upper bowel resection, where a trans mesorectal technique should be preferred to prevent devascularization and denervation of the bowel segments not affected by the disease.
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Affiliation(s)
- Gabriele Centini
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Luca Labanca
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Matteo Giorgi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Francesco Giuseppe Martire
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Francesco Catania
- Department of Surgical Sciences, Gynecological Unit, Valdarno Hospital, Montevarchi, Italy
| | - Errico Zupi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
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12
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Garzon S, Laganà AS, Guerriero S, Alcázar JL, Dababou S, Uccella S, Scioscia M. Transvaginal Sonography for the Preoperative Assessment of Parametrial Deep Infiltrating Endometriosis: A Diagnostic Accuracy Study. Gynecol Obstet Invest 2024; 89:111-119. [PMID: 38377973 DOI: 10.1159/000535940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/15/2023] [Indexed: 02/22/2024]
Abstract
OBJECTIVE The aim of the study was to evaluate the diagnostic accuracy for parametria endometriosis (PE) of transvaginal sonography (TVS) performed following a systematic approach for the assessment of the lateral parametria. DESIGN A diagnostic accuracy study was employed based on a prospective observational design. PARTICIPANTS All consecutive patients who underwent laparoscopic surgery for endometriosis between January 2016 and December 2020 were considered. SETTING The study was conducted at endometriosis referral hospitals. METHODS We prospectively collected clinical, imaging, and surgical data of all consecutive patients who underwent laparoscopic surgery for endometriosis between January 2016 and December 2020. A standardized technique with a systematic approach for the assessment of the lateral parametria following specific anatomic landmarks was used for the TVS. The diagnostic accuracy for PE in TVS was assessed using the intraoperative and pathologic diagnosis of PE as the gold standard. RESULTS In 476 patients who underwent surgery, PE was identified in 114 out of 476 patients (23.95%): 91 left and 54 right PE out of 476 surgical procedures were identified (19.12% vs. 11.34%; p = 0.001); bilateral involvement in 27.19% (31/114 patients) cases. The sensitivity of TVS for PE was 90.74% (79.70-96.92%, 95% CI) for the right side and 87.91% (79.40-93.81%, 95% CI) for the left side. The specificity was almost identical for both sides (98.58% vs. 98.18%). For the right parametrium, the positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 63.82 (28.70-141.90, 95% CI) and 0.09 (0.04-0.22, 95% CI), respectively. On the left parametrium, the PLR and NLR were 48.35 (23.12-101.4, 95% CI) and 0.12 (0.07-0.21, 95% CI), respectively. The diagnostic accuracy for right and left PE was 97.69% (95.90-98.84%, 95% CI) and 96.22% (94.04-97.74%, 95% CI), respectively. LIMITATIONS The principal limit is the high dependence of TVS on the operator experience. Therefore, although a standardized approach following precise definitions of anatomical landmarks was used, we cannot conclude that the observed accuracy of TVS for PE is the same for all sonographers. In this regard, the learning curve was not assessed. In the case of negative TVS for parametrial involvement with an absent intraoperative suspect, a complete dissection of the parametrium was not performed to avoid surgical complications; therefore, cases of minor PE may be missed, underestimating false negatives. CONCLUSIONS TVS performed following a systematic approach for assessing the lateral parametria seems to have good diagnostic accuracy for PE with large changes in the posttest probability of parametrial involvement based on the TVS evaluation. Considering the clinical and surgical implications of PE, further studies implementing a standardized approach for assessing the parametrium by TVS are recommended to confirm our observations and implement a standardized protocol in clinical practice.
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Affiliation(s)
- Simone Garzon
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University Hospital of Verona, University of Verona, Verona, Italy
| | - Antonio Simone Laganà
- Department of Health Promotion, Mother and Child Care, Internal Medicine, and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Stefano Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Monserrato, Italy
| | - Juan Luis Alcázar
- Department of Obstetrics and Gynecology, Clínica Universitad de Navarra, Pamplona, Spain
| | - Susan Dababou
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University Hospital of Verona, University of Verona, Verona, Italy
| | - Stefano Uccella
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University Hospital of Verona, University of Verona, Verona, Italy
| | - Marco Scioscia
- Unit of Gynecological Surgery, Mater Dei Hospital, Bari, Italy
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13
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Turco LC, Raimondo D, Raffone A, Raimondo I, Vargiu V, Raspollini A, Travaglino A, Tinelli R, Zanetti E, Ferrandina G, Seracchioli R, Casadio P, Scambia G, Cosentino F. Horizontal versus vertical direction of posterior vaginal wall suture after eradication of rectovaginal endometriosis: A multicenter study. Int J Gynaecol Obstet 2024; 164:550-556. [PMID: 37715533 DOI: 10.1002/ijgo.15109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE To compare safety and effectiveness of two-different directions of suturing the posterior vaginal breach (horizontal [Ho] vs vertical [Ve]) in women undergoing recto-vaginal endometriosis (RVE) nodule resection. METHODS A multicenter, retrospective, observational, cohort study was performed including all women of reproductive age undergoing RVE nodule resection between March 2013 and December 2018 at our tertiary centers. Patients included in the present study were divided into two groups based on the direction in suturing the posterior vaginal fornix defect, for comparisons in terms of rate of postoperative complications, pain relief, pain and anatomical recurrence, and length of hospital stay. Univariate comparisons were performed adopting the t test or the Mann-Whitney test for continuous data and the chi-square test or the Fisher exact test for categorical data, with a significant P value set to <0.05. RESULTS A total of 101 women were included: 67 in the Ho-group and 34 in the Ve-group. The two groups did not significantly differ in length of hospital stay (6.7 ± 6.9 vs 6.6 ± 3.3 days; P = 0.95), overall postoperative complications (32.8% vs 14.7%; P = 0.05), pain recurrence (35.8% vs 26.5%; P = 0.34) and anatomical recurrence rate (19.4% vs 23.5%; P = 0.62). Conversely, grade III complications were significantly more common in the Ho-group than in the Ve-group (22.7% vs 20%, P = 0.009), while pain relief in terms of deep dyspareunia, dyschezia, dysuria and chronic pelvic pain was more consistent in the Ve-group patients (P = 0.04, 0.04, 0.05, 0.004, respectively). CONCLUSION In symptomatic women undergoing RVE nodule resection, Ho suturing of the vaginal breach appears more commonly associated with severe postoperative complications and a worse pain control.
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Affiliation(s)
- Luigi Carlo Turco
- Ovarian Cancer Center, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy
| | - Diego Raimondo
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Antonio Raffone
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Ivano Raimondo
- Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
- Gynecology and Breast Care Unit, Mater Olbia Spa, Olbia, Italy
| | - Virginia Vargiu
- Department of Medicine and Health Science, "V.Tiberio" Università Degli Studi del Molise, Campobasso, Italy
- Gynecologic Onocology Unit, Gemelli Molise SpA, Campobasso, Italy
| | - Arianna Raspollini
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Antonio Travaglino
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Pathology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Raffaele Tinelli
- Department of Obstetrics and Gynecology, Antonio Perrino Hospital, Brindisi, Italy
| | - Enrico Zanetti
- Gynecology and Obstetrics Unit, University of Brescia, Italy
| | - Gabriella Ferrandina
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy
| | - Renato Seracchioli
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Paolo Casadio
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giovanni Scambia
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy
| | - Francesco Cosentino
- Department of Medicine and Health Science, "V.Tiberio" Università Degli Studi del Molise, Campobasso, Italy
- Gynecologic Onocology Unit, Gemelli Molise SpA, Campobasso, Italy
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14
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Pavone M, Seeliger B, Alesi MV, Goglia M, Marescaux J, Scambia G, Ianieri MM. Initial experience of robotically assisted endometriosis surgery with a novel robotic system: first case series in a tertiary care center. Updates Surg 2024; 76:271-277. [PMID: 38133880 DOI: 10.1007/s13304-023-01724-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023]
Abstract
Endometriosis is a benign disease requiring surgery if medical treatment can not achieve symptom control. Laparoscopy remains the gold standard and robotic assistance can be beneficial in complex cases. Robot-assisted radical endometriosis excision using the Hugo™ RAS system is a novel approach. The aim of this study is to describe its setting and outcomes in a series of patients in a robotic surgery center. Endometriosis patients who consecutively underwent robot-assisted surgery with the Hugo™ RAS system (Medtronic, USA) were retrospectively enrolled. Disease-specific symptoms before and after surgery, endometriosis stage, as well as perioperative and intraoperative variables including system setup were collected. Early post-operative complications (< 30 days) and follow-up (up to 3 months) were reported. All procedures were completed robotically. Port placement followed the "bridge" configuration with a "compact" docking. The median operative time was 186.5 min (IQR 174-220), the median estimated blood loss 50 ml (IQR 0-100). An intraoperative complication occurred in one patient (6.6%), a bladder laceration with postoperative antibiotic treatment. The median lenght of hospital stay (LOS) was 3 days (IQR 3-4). Surgery achieved a statistically significant decrease in symptoms: mean dysmenorrhea (9.50 ± 0.83 versus 1.7 ± 2.26; p = 0.001), dyschezia (4.27 ± 3.61 versus 2.40 ± 2.92; p = 0.026), dysuria (2.73 ± 3.39 versus 1.87 ± 2.41; p = 0.358), dyspareunia (6.53 ± 3.15 versus 2.93 ± 2.89; p = 0.002) and chronic pelvic pain (8.8 ± 1.20 versus 3.20 ± 2.39; p = 0.001). The integration of this platform in the described configuration was safe with regular perioperative outcomes and significant improvement in symptoms. Prospective comparative studies with a larger cohort and longer follow-up are needed to assess potential advantages over the current gold standard.
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Affiliation(s)
- Matteo Pavone
- Dipartimento di Scienze per la Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Largo Agostino Gemelli 8, 00168, Rome, Italy.
- IHU Strasbourg , Institute of Image-Guided Surgery, Strasbourg, France.
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France.
| | - Barbara Seeliger
- IHU Strasbourg , Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- Department of Visceral and Digestive Surgery, University Hospitals of Strasbourg, Strasbourg, France
- ICube, UMR 7357 CNRS, University of Strasbourg, Strasbourg, France
| | - Maria Vittoria Alesi
- Dipartimento di Scienze per la Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Marta Goglia
- IHU Strasbourg , Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- Department of Translational Medicine and Oncology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Jacques Marescaux
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Giovanni Scambia
- Dipartimento di Scienze per la Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Manuel Maria Ianieri
- Dipartimento di Scienze per la Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
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15
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Ianieri MM, De Cicco Nardone A, Benvenga G, Greco P, Pafundi PC, Alesi MV, Campolo F, Lodoli C, Abatini C, Attalla El Halabieh M, Pacelli F, Scambia G, Santullo F. Vascular- and nerve-sparing bowel resection for deep endometriosis: A retrospective single-center study. Int J Gynaecol Obstet 2024; 164:277-285. [PMID: 37555349 DOI: 10.1002/ijgo.15019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 06/30/2023] [Accepted: 07/10/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE Surgical management of bowel endometriosis is still controversial. Recently, many authors have pointed out the potential benefits of preserving the superior rectal artery, thus ensuring better perfusion of the anastomosis. The aim of this study was to evaluate the complication rate and functional outcomes of a bowel resection technique for deep endometriosis (DE) involving a nerve- and vascular-sparing approach. METHODS A single-center retrospective study was conducted by enrolling patients who underwent segmental resection of the rectus sigmoid for DE in our department between September 2019 and April 2022. Intraoperative and postoperative complications were recorded for each woman, and functional outcomes relating to the pelvic organs were assessed using validated questionnaires (Knowles-Eccersley-Scott-Symptom [KESS] questionnaire and Gastro-Intestinal Quality of Life Index [GIQLI] for bowel function, Bristol Female Lower Urinary Tract Symptoms [BFLUTS] for urinary function, and Female Sexual Function Index [FSFI] for sexual function). These were evaluated preoperatively and postoperatively after 6 months from surgery. RESULTS Sixty-one patients were enrolled. No patients had Clavien-Dindo grade 3 or 4 complications, there were no rectovaginal fistulas or ureteral lesions, and in no cases was it necessary to reoperate. Temporary bladder voiding deficits were reported in 8.2% of patients, which were treated with self-catheterizations, always resolving within 45 days of surgery. Gastrointestinal function evaluated by KESS and GIQLI improved significantly after surgery, whereas sexual function appeared to worsen, although without reaching the level of statistically significant validity. CONCLUSION Our vascular- and nerve-sparing segmental bowel resection technique for DE had a low intraoperative and postoperative complication rate and produced an improvement in gastrointestinal function after surgery.
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Affiliation(s)
- Manuel Maria Ianieri
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Unit of Oncological Gynecology, Women's Children's and Public Health Department, Rome, Italy
| | - Alessandra De Cicco Nardone
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Unit of Oncological Gynecology, Women's Children's and Public Health Department, Rome, Italy
| | | | | | - Pia Clara Pafundi
- Epidemiology and Biostatistics Research Core Facility, Gemelli Generator, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Federica Campolo
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Unit of Oncological Gynecology, Women's Children's and Public Health Department, Rome, Italy
| | - Claudio Lodoli
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Carlo Abatini
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Miriam Attalla El Halabieh
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Fabio Pacelli
- Catholic University of the Sacred Heart, Rome, Italy
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Unit of Oncological Gynecology, Women's Children's and Public Health Department, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Santullo
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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16
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Zhang S, Jiang X, Mao P. Laparoscopic treatment of colonic endometriosis causing periodic abdominal pain and hematochezia: A case report. Medicine (Baltimore) 2023; 102:e36229. [PMID: 38013332 PMCID: PMC10681378 DOI: 10.1097/md.0000000000036229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023] Open
Abstract
RATIONALE Endometriosis, a benign disease, has a malignant biological behavior and is highly prone to recurrence. Although gastrointestinal involvement is the most common site for extra-genital endometriosis, deep infiltrative endometriosis, which affects the mucosal layer, is very rare. PATIENT CONCERNS A 44-year-old woman with a 6-month history of recurring abdominal pain and Hematochezia. The patient visited several hospitals over the past six months and was suspected to have been diagnosed with a digestive disease, for which medication was ineffective, leading to a great deal of anxiety. DIAGNOSES Colonic endometriosis. INTERVENTIONS After a thorough imaging evaluation and preoperative discussion, laparoscopic colonic endometriosis resection under indocyanine green indication was performed by gynecologists and gastroenterologists. OUTCOMES After laparoscopic treatment, the patient's symptoms improved significantly, with occasional pain felt and no blood in the stool. LESSONS This case provides a rare example of sigmoid endometriosis causing periodic abdominal pain and Hematochezia. We report a clinical case to investigate the feasibility of an indocyanine green fluorescent contrast technique to guide the scope of surgery in laparoscopic deep infiltrative endometriosis surgery. In intestinal endometriosis surgery, indocyanine green fluoroscopy may indicate the lesion's precise localization.
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Affiliation(s)
- Shiting Zhang
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xuelu Jiang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Peiyu Mao
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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17
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Cervantes GV, Ribeiro PAAG, Tomasi MC, Farah D, Ribeiro HSAA. Sexual Function of Patients with Deep Endometriosis after Surgical Treatment: A Systematic Review. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:e729-e744. [PMID: 38029775 PMCID: PMC10686762 DOI: 10.1055/s-0043-1772596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/11/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVE To review the current state of knowledge on the impact of the surgical treatment on the sexual function and dyspareunia of deep endometriosis patients. DATA SOURCE A systematic review was conducted in accordance with the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. We conducted systematic searches in the PubMed, EMBASE, LILACS, and Web of Science databases from inception until December 2022. The eligibility criteria were studies including: preoperative and postoperative comparative analyses; patients with a diagnosis of deep endometriosis; and questionnaires to measure sexual quality of life. STUDY SELECTION Two reviewers screened and reviewed 1,100 full-text articles to analyze sexual function after the surgical treatment for deep endometriosis. The risk of bias was assessed using the Newcastle-Ottawa scale for observational studies and the Cochrane Collaboration's tool for randomized controlled trials. The present study was registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration CRD42021289742). DATA COLLECTION General variables about the studies, the surgical technique, complementary treatments, and questionnaires were inserted in an Microsoft Excel 2010 (Microsoft Corp., Redmond, WA, United States) spreadsheet. SYNTHESIS OF DATA We included 20 studies in which the videolaparoscopy technique was used for the excision of deep infiltrating endometriosis. A meta-analysis could not be performed due to the substantial heterogeneity among the studies. Classes III and IV of the revised American Fertility Society classification were predominant and multiple surgical techniques for the treatment of endometriosis were performed. Standardized and validated questionnaires were applied to evaluate sexual function. CONCLUSION Laparoscopic surgery is a complex procedure that involves multiple organs, and it has been proved to be effective in improving sexual function and dyspareunia in women with deep infiltrating endometriosis.
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Affiliation(s)
- Graziele Vidoto Cervantes
- Department of Gynecology, Endometriosis and Laparoscopic Surgery Center, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Paulo Augusto Ayroza Galvão Ribeiro
- Department of Gynecology, Endometriosis and Laparoscopic Surgery Center, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Mariana Carpenedo Tomasi
- Department of Gynecology, Endometriosis and Laparoscopic Surgery Center, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Daniela Farah
- Department of Gynecology, Women's Health Technology Assessment Center, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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18
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Ye F, Su H, Xiong H, Luo W, Huang Z, Chen G, Zhou H. Applied anatomy of female pelvic plexus for nerve-sparing radical hysterectomy(NSRH). BMC Womens Health 2023; 23:533. [PMID: 37817116 PMCID: PMC10566162 DOI: 10.1186/s12905-023-02651-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/12/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Nerve-sparing radical hysterectomy(NSRH)has the advantage of reducing postoperative complications and improving postoperative quality of life. The separation and protection of the pelvic plexus in NSRH is extremely important and challenging. METHODS 24 female cadaveric hemipelves were dissected. Morphologic patterns and compositions of pelvic plexus as well as relationship of pelvic plexus to the surrounding structures were observed and documented. RESULTS Two patterns of superior hypogastric plexus were observed, including fenestrated and cord-like shape. The origin of bilateral hypogastric nerves were inferiorly to upper margin of promontory about 1.6 ± 0.1 cm and parallel to the ureter in front of the sacrum. Pelvic splanchnic nerves(PSN)from the second sacral nerve, the third sacral nerve and the forth sacral nerve were observed combing with the hypogastric nerves within the lateral rectal ligament. The sacral sympathetic trunk can be identified anteriorly or medially to the anterior sacral foramen. We identified the boundaries of pelvic plexus as following: the upper margin is formed by the PSNs from the third sacral nerve, posterior margin by inferior rectal artery, and anteriorly by vesical venous plexus. The uterine branches from pelvic plexus were observed accompanying with uterine artery, while other branches were inferiorly to the artery. The PSNs were located beneath the deep uterine veins within the cardinal ligament. The upper margin of pelvic plexus was observed directly approach to urinary bladder within the vesico-vaginal ligament as a single trunk accompanying with ureter, between the middle and inferior vesical veins. CONCLUSIONS Our study clarified the intricate arrangement, distribution and relationship of female pelvic plexus and the related structures to provide reference index for NSRH application. The innervation patterns of bladder and uterine were clarified, and by tracing these visceral branches of pelvic plexus, we suggest several new important land markers for NSRH.
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Affiliation(s)
- Fan Ye
- Department of Human Anatomy, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Hongyu Su
- Department of Human Anatomy, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Hang Xiong
- Department of Human Anatomy, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Wenxin Luo
- West China School of Stomatology, Sichuan University, Chengdu, China
| | - ZiHeng Huang
- West China School of Stomatology, Sichuan University, Chengdu, China
| | - Guoqing Chen
- Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
| | - Hongying Zhou
- Department of Human Anatomy, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, Sichuan, China.
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19
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Ianieri MM, Nardone ADC, Pavone M, Benvenga G, Pafundi MP, Campolo F, Foschi N, Greco P, Brutto M, Scambia G. Are ureterolysis for deep endometriosis really all the same? An anatomical classification proposal for ureterolysis: A single-center experience. Int J Gynaecol Obstet 2023; 162:1010-1019. [PMID: 37069787 DOI: 10.1002/ijgo.14790] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 03/16/2023] [Accepted: 03/28/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVE Ureteral endometriosis has an incidence of 0.1% to 1%. The type of surgery required is either conservative (ureterolysis) or radical treatment, depending on the degree of ureter infiltration. The incidence of intraoperative and postoperative complications is heterogeneous. Thus, the aim of the current study was to propose a classification of ureterolysis based on the anatomical structure of the ureter and differing complication rates with procedures. METHODS A total of 139 ureterolysis procedures were included in the study. Patients were divided into three groups according to the depth of ureterolysis required. Differences were recorded across the three types of ureterolysis in terms of intraoperative and postoperative complications. RESULTS The incidence of ureteral fistula was reported in 0.7% of cases, with postoperative ureteral stenosis in 2% of type 2 ureterolysis. In the case of type 3 ureterolysis, after conservative procedures, 52.9% of patients required an ureteroneocystostomy to solve the ureteral stenosis. CONCLUSION The risk of ureteral injury and ureteroneocystostomy after conservative procedures appears to be associated with type 3 ureterolysis, probably due to excessive devascularization, secondary to the incision of adventitia. Obviously, these data should be confirmed through a prospective study of a larger number, but our proposed classification can provide the basis for making data from future studies more comparable.
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Affiliation(s)
- Manuel Maria Ianieri
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Unit of Oncological Gynecology, Women's Children's and Public Health Department, Rome, Italy
| | - Alessandra De Cicco Nardone
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Unit of Oncological Gynecology, Women's Children's and Public Health Department, Rome, Italy
| | - Matteo Pavone
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Unit of Oncological Gynecology, Women's Children's and Public Health Department, Rome, Italy
| | - Greta Benvenga
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Unit of Oncological Gynecology, Women's Children's and Public Health Department, Rome, Italy
| | - Maria Pia Pafundi
- Facility of Epidemiology and Biostatistics - GEMELLI GENERATOR, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Federica Campolo
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Unit of Oncological Gynecology, Women's Children's and Public Health Department, Rome, Italy
| | - Nazario Foschi
- Urology Division, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Pierfrancesco Greco
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Unit of Oncological Gynecology, Women's Children's and Public Health Department, Rome, Italy
| | - Mariafrancesca Brutto
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Unit of Oncological Gynecology, Women's Children's and Public Health Department, Rome, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Unit of Oncological Gynecology, Women's Children's and Public Health Department, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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20
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Ngernprom P, Klangsin S, Suwanrath C, Peeyananjarassri K. Risk factors for recurrent endometriosis after conservative surgery in a quaternary care center in southern Thailand. PLoS One 2023; 18:e0289832. [PMID: 37561776 PMCID: PMC10414623 DOI: 10.1371/journal.pone.0289832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 07/26/2023] [Indexed: 08/12/2023] Open
Abstract
OBJECTIVES To determine the 2-year recurrence rate of endometriosis after conservative surgery and the risk factors for recurrence. METHODS This study retrospectively analyzed women with endometriosis who underwent conservative surgery and had at least a 2-year follow-up at a quaternary care hospital in southern Thailand from January 2000 to December 2019. Recurrent endometriosis was defined as either presence of endometrioma with a diameter ≥ 2 cm for more than three consecutive menstrual cycles or relapse of pelvic pain with the same or higher visual analog scale (VAS) score as before surgery. Multivariate logistic regression analysis was used to identify the risk factors for recurrence. RESULTS The median (interquartile range [IQR]) age was 34 (29, 38) years in 362 cases and nearly three-quarters (74.2%) were nulliparous. Cyclic pain was the most common clinical presentation (48.9%) and the median (IQR) VAS score of pelvic pain was 6 (5, 9). Ovarian cystectomy was the most common procedure (68.1%). The 2-year recurrent endometriosis rate after conservative surgery was 23.2%, and the overall recurrence rate was 56.4%. The risk factors of recurrence were preoperative moderate to severe pelvic pain (adjusted odds ratio [aOR] 1.93; 95% confidence interval [CI], 1.12-3.34; p = 0.017), adhesiolysis/ablation/ovarian cystectomy without unilateral oophorectomy (aOR 2.71; 95% CI, 1.40-5.23; p = 0.002), and duration of postoperative hormonal treatment < 24 months (aOR 10.58; 95% CI, 5.47-20.47; p < 0.001). CONCLUSION The 2-year recurrence rate after conservative surgery for endometriosis was 23.2%. Preoperative moderate to severe pelvic pain, procedures except unilateral oophorectomy, and postoperative hormonal treatment < 24 months were risk factors for recurrence.
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Affiliation(s)
- Pongpan Ngernprom
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Satit Klangsin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Chitkasaem Suwanrath
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Krantarat Peeyananjarassri
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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21
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Asencio FDA, Fins RJP, Mitie CK, Ussia A, Wattiez A, Ribeiro HS, Ribeiro PA, Koninckx PR. Segmental Rectum Resection for Deep Endometriosis and Excision Similarly Improve Sexual Function and Pain. Clin Pract 2023; 13:780-790. [PMID: 37489420 PMCID: PMC10366930 DOI: 10.3390/clinpract13040071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/08/2023] [Accepted: 06/30/2023] [Indexed: 07/26/2023] Open
Abstract
Segmental rectum resections for indications other than endometriosis were reported to result in up to 40% sexual dysfunctions. We, therefore, evaluated sexual function after low bowel resection (n = 33) for deep endometriosis in comparison with conservative excision (n = 23). Sexual function was evaluated with the FSFI-19 (Female Sexuality Functioning Index) and EHP 30 (Endometriosis Health Profile). The pain was evaluated with visual analogue scales. Linear excision and bowel resections improved FSFI, EHP 30, and postoperative pain comparably. By univariate analysis, a decreased sexual function was strongly associated with pain both before (p < 0.0001) and after surgery (p = 0.0012), age (p = 0.05), and duration of surgery (p = 0.023). By multivariate analysis (proc logistic), the FSFI after surgery was predicted only by FSFI before or EHP after surgery. No differences were found between low bowel segmental resection and a more conservative excision. In conclusion, improving pain after surgery can explain the improvement in sexual function. A deleterious effect of a bowel resection on sexual function was not observed for endometriosis. Sexual function in women with endometriosis can be evaluated using a simplified questionnaire such as FSFI-6.
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Affiliation(s)
| | | | - Carolina Kami Mitie
- Medicine College, University of Santa Casa de São Paulo, São Paulo 01224-001, Brazil
| | - Anastasia Ussia
- Gemelli Hospital, Universtità Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Arnauld Wattiez
- Department of Obstetrics and Gynaecology, University of Strasbourg, 67081 Strasbourg, France
- Latifa Hospital, Dubai P.O. Box 9115, United Arab Emirates
| | | | - Paulo Ayrosa Ribeiro
- Department of Gynaecology Endoscopy, Santa Casa de São Paulo Hospital, São Paulo 01221-010, Brazil
| | - Philippe Robert Koninckx
- Latifa Hospital, Dubai P.O. Box 9115, United Arab Emirates
- Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Catholic University Leuven, 3000 Leuven, Belgium
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22
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Bahrami F, Maheux-Lacroix S, Bougie O, Boutin A. Complications following surgeries for endometriosis: A systematic review protocol. PLoS One 2023; 18:e0285929. [PMID: 37220161 DOI: 10.1371/journal.pone.0285929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 04/27/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Endometriosis is a common gynecological condition with a wide range of symptoms, including infertility, dyspareunia, intestinal disorders, and pelvic pain. Laparoscopy and laparotomy are used widely for diagnosing and managing endometriosis. We will conduct a systematic review and meta-analysis with the aims of reporting complications rates following each type of surgeries for endometriosis and determinants of complications. METHOD We will search Medline (via PubMed), Embase, the Cochrane Library, Web of Science, and Google Scholar for both retrospective and prospective cohorts or trials of at least 30 participants reporting perioperative and postoperative complications for endometriosis surgeries. We will restrict the studies to those conducted after 2011, to be representative of current practices, and will exclude studies of surgeries for gynecological cancer, or other concomitant benign gynecologic surgeries such as myomectomy. Two reviewers will independently screen references and select eligible studies. A standardized form will be used to collect data related to the baseline characteristics, potential determinants of complications, types of interventions, and outcomes. Cumulative incidences of complications will be pooled using DerSimonian and Laird random-effects method. The relation between potential determinants and complications will be reported with risk ratios and their 95% of confidence intervals. Subgroup analysis of surgical approach, surgical procedure, superficial and deep infiltrating endometriosis, and the indication of surgery will be conducted. Sensitivity analyses restricted to studies with low risk of bias will be performed. DISCUSSION This systematic review will provide information on the rates of complications for different surgical approaches and procedures for the treatment of endometriosis. It will contribute to inform patients when making decisions regarding their care. Identifying potential determinants of complications will also help to improve care by identifying women being at higher risk of complications. TRIAL REGISTRATION Systematic review registration: CRD42021293865.
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Affiliation(s)
- Foruzan Bahrami
- Reproduction, Mother and Youth Health Unit, CHU de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
| | - Sarah Maheux-Lacroix
- Reproduction, Mother and Youth Health Unit, CHU de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
- Department of Obstetrics and Gynaecology, Université Laval, Quebec City, Quebec, Canada
| | - Olga Bougie
- Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada
| | - Amélie Boutin
- Reproduction, Mother and Youth Health Unit, CHU de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
- Population Health and Optimal Health Practices Unit, CHU de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
- Department of Pediatrics, Université Laval, Quebec City, Quebec, Canada
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23
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Ianieri MM, Rosati A, Ercoli A, Foschi N, Campolo F, Greco P, Scambia G. Laparoscopic ureteroneocystostomy and round ligament bladder hitching for ureteral stenosis in parametrial deep endometriosis: Our tips for a tension-free anastomosis. Int J Gynaecol Obstet 2023; 160:563-570. [PMID: 35965391 DOI: 10.1002/ijgo.14402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 07/20/2022] [Accepted: 08/09/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To investigate the feasibility and the efficacy of laparoscopic ureteroneocystostomy with round ligament bladder hitching. METHODS This is a monocentric retrospective study. Enrolled patients affected by deep endometriosis underwent laparoscopic nerve-sparing parametrectomy and monolateral ureteroneocystostomy with bladder suspension to the round ligament. Perioperative and postoperative outcomes were collected, as well as urinary and pain symptoms before and after surgery. RESULTS Laparoscopic ureteroneocystostomy with round ligament bladder hitching was performed in nine women. The most frequent postoperative complication was post-voiding urinary retention (22.2%). No ureteral fistula or stenosis of the anastomosis was reported. CONCLUSION In selected cases of ureteral resection and reimplantation, performing a round ligament bladder hitching allowed us to overcome the ureteral gap. This is a safe and feasible procedure to ensure stability of the anastomosis and avoid the possible disadvantages of the "standard" psoas hitch procedure.
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Affiliation(s)
- Manuel Maria Ianieri
- Division of Gynecologic Oncology, Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Andrea Rosati
- Division of Gynecologic Oncology, Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alfredo Ercoli
- Department of Human Pathology of the Adult and of the Childhood "Gaetano Barresi", University of Messina, Messina, Italy
| | - Nazario Foschi
- Division of Urology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Federica Campolo
- Division of Gynecologic Oncology, Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Giovanni Scambia
- Division of Gynecologic Oncology, Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Human Pathology of the Adult and of the Childhood "Gaetano Barresi", University of Messina, Messina, Italy.,Division of Urology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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24
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Gremillet L, Netter A, Sari-Minodier I, Miquel L, Lacan A, Courbiere B. Endometriosis, infertility and occupational life: women's plea for recognition. BMC Womens Health 2023; 23:29. [PMID: 36670397 PMCID: PMC9853480 DOI: 10.1186/s12905-023-02183-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/17/2023] [Indexed: 01/21/2023] Open
Abstract
The objective of this study was to explore and describe the specificities of the occupational life of infertile endometriotic women treated by in vitro fertilization. We conducted a qualitative monocentric study between December 2020 and June 2021. Twelve semi-structured in-depth interviews using a theme-based interview guide with open questions were undertaken with infertile women with deep infiltrating endometriosis. Data analysis was conducted using an inductive approach according to the grounded theory method. Three main themes emerged from the interviews: (i) barriers to reconciling illness and work life, (ii) facilitating factors for well-being at work, and (iii) consequences and outlooks. It appeared that the time of infertility treatment represents a particular period of change in the working lives of women with endometriosis. For most women, these changes are experienced negatively, often with a renunciation of goals. For others, this is the time to communicate the difficulties linked to their illness to their professional entourage. There is a long path ahead to finally achieving recognition of endometriosis in the context of professional life.
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Affiliation(s)
- Letizia Gremillet
- grid.411535.70000 0004 0638 9491Department of Gynecology-Obstetrics and Reproductive Medicine, AP-HM, La Conception Hospital, 147 Boulevard Baille, Marseille, France
| | - Antoine Netter
- grid.411535.70000 0004 0638 9491Department of Gynecology-Obstetrics and Reproductive Medicine, AP-HM, La Conception Hospital, 147 Boulevard Baille, Marseille, France ,grid.7310.50000 0001 2190 2394CNRS, IRD, IMBE UMR 7263 FR, AP-HM, Aix Marseille Univ, Avignon University, Marseille, France
| | - Irène Sari-Minodier
- grid.7310.50000 0001 2190 2394CNRS, IRD, IMBE UMR 7263 FR, AP-HM, Aix Marseille Univ, Avignon University, Marseille, France ,grid.414336.70000 0001 0407 1584Faculty of Medical and Paramedical Sciences, AP-HM La Timone, University Hospital Service of Medicine and Occupational Health, Aix Marseille Univ 27, Boulevard Jean Moulin, 13385 Marseille Cedex 5, France
| | - Laura Miquel
- grid.411535.70000 0004 0638 9491Department of Gynecology-Obstetrics and Reproductive Medicine, AP-HM, La Conception Hospital, 147 Boulevard Baille, Marseille, France
| | - Arnaud Lacan
- grid.17673.340000 0001 2325 5880AMSE, CNRS, UMR 7316, Kedge Business School, EHESS, Marseille, France
| | - Blandine Courbiere
- grid.411535.70000 0004 0638 9491Department of Gynecology-Obstetrics and Reproductive Medicine, AP-HM, La Conception Hospital, 147 Boulevard Baille, Marseille, France ,grid.7310.50000 0001 2190 2394CNRS, IRD, IMBE UMR 7263 FR, AP-HM, Aix Marseille Univ, Avignon University, Marseille, France
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Raimondo D, Raffone A, Renzulli F, Sanna G, Raspollini A, Bertoldo L, Maletta M, Lenzi J, Rovero G, Travaglino A, Mollo A, Seracchioli R, Casadio P. Prevalence and Risk Factors of Central Sensitization in Women with Endometriosis. J Minim Invasive Gynecol 2023; 30:73-80.e1. [PMID: 36441085 DOI: 10.1016/j.jmig.2022.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/05/2022]
Abstract
STUDY OBJECTIVE To assess prevalence of central sensitization (CS) and its association with demographic and clinical factors in patients with endometriosis. DESIGN Single-center, observational, cross-sectional study. SETTING Tertiary center. PATIENTS Consecutive patients with endometriosis referred to the center from January 15, 2022, to April 30, 2022. INTERVENTIONS For each enrolled patient, demographic and clinical data were collected, and the presence of CS was measured using the CS Inventory questionnaire (score ≥40). MEASUREMENTS AND MAIN RESULTS Primary study outcome was CS prevalence, and secondary study outcomes were the associations between demographic and clinical factors and CS. The 95% confidence intervals for CS prevalence were obtained with Bayesian-derived Jeffreys method, and the associations between CS and demographic and clinical factors were evaluated with the chi-square test and Fisher's exact test, where appropriate. The variables significantly associated with CS were then included in a multivariable logistic regression model. The significance level was set at .05 for all analyses. During the study period, 285 eligible women were enrolled. CS prevalence was 41.4% (95% confidence interval, 35.8-47.2). At univariable analysis, infertility, moderate to severe pain symptoms (except for dyschezia), altered bowel movements, posterolateral parametrium involvement, hormonal therapy failure (HTF), and most of central sensitivity syndromes were significantly associated with CS occurrence. Multivariable analysis only confirmed the significant association of CS with moderate to severe chronic pelvic pain, posterolateral parametrium involvement, HTF, migraine or tension-type headache, irritable bowel syndrome, and anxiety or panic attacks. CONCLUSION CS has a high prevalence in patients with endometriosis, especially in those with moderate to severe chronic pelvic pain, posterolateral parametrium involvement, HTF, and 3 central sensitivity syndromes (i.e. migraine or tension-type headache, irritable bowel syndrome, anxiety or panic attacks). Given the association with HTF, identifying CS through CS Inventory might be useful to counsel the patient and to choose multimodal treatment.
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Affiliation(s)
- Diego Raimondo
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna (Drs. Raimondo, Raffone, Renzulli, Raspollini, Bertoldo, Maletta, Rovero, Seracchioli, and Casadio), Bologna, Italy
| | - Antonio Raffone
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna (Drs. Raimondo, Raffone, Renzulli, Raspollini, Bertoldo, Maletta, Rovero, Seracchioli, and Casadio), Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna (Drs. Raffone, Renzulli, Sanna, Raspollini, Bertoldo, Maletta, Rovero, and Seracchioli), Bologna, Italy.
| | - Federica Renzulli
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna (Drs. Raimondo, Raffone, Renzulli, Raspollini, Bertoldo, Maletta, Rovero, Seracchioli, and Casadio), Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna (Drs. Raffone, Renzulli, Sanna, Raspollini, Bertoldo, Maletta, Rovero, and Seracchioli), Bologna, Italy.
| | - Giada Sanna
- Department of Medical and Surgical Sciences, University of Bologna (Drs. Raffone, Renzulli, Sanna, Raspollini, Bertoldo, Maletta, Rovero, and Seracchioli), Bologna, Italy
| | - Arianna Raspollini
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna (Drs. Raimondo, Raffone, Renzulli, Raspollini, Bertoldo, Maletta, Rovero, Seracchioli, and Casadio), Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna (Drs. Raffone, Renzulli, Sanna, Raspollini, Bertoldo, Maletta, Rovero, and Seracchioli), Bologna, Italy
| | - Linda Bertoldo
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna (Drs. Raimondo, Raffone, Renzulli, Raspollini, Bertoldo, Maletta, Rovero, Seracchioli, and Casadio), Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna (Drs. Raffone, Renzulli, Sanna, Raspollini, Bertoldo, Maletta, Rovero, and Seracchioli), Bologna, Italy
| | - Manuela Maletta
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna (Drs. Raimondo, Raffone, Renzulli, Raspollini, Bertoldo, Maletta, Rovero, Seracchioli, and Casadio), Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna (Drs. Raffone, Renzulli, Sanna, Raspollini, Bertoldo, Maletta, Rovero, and Seracchioli), Bologna, Italy
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna (Dr. Lenzi), Bologna, Italy
| | - Giulia Rovero
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna (Drs. Raimondo, Raffone, Renzulli, Raspollini, Bertoldo, Maletta, Rovero, Seracchioli, and Casadio), Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna (Drs. Raffone, Renzulli, Sanna, Raspollini, Bertoldo, Maletta, Rovero, and Seracchioli), Bologna, Italy
| | - Antonio Travaglino
- Gynecopathology and Breast Pathology Unit, Department of Woman and Child's Health Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS (Dr. Travaglino), Rome, Italy; Pathology Unit, Department of Advanced Biomedical Sciences, University of Naples "Federico II," Naples (Dr. Travaglino)
| | - Antonio Mollo
- Gynecology and Obstetrics Unit, Department of Medicine, Surgery and Dentistry "Schola Medica Salernitana," University of Salerno, Baronissi (Dr. Mollo), Italy
| | - Renato Seracchioli
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna (Drs. Raimondo, Raffone, Renzulli, Raspollini, Bertoldo, Maletta, Rovero, Seracchioli, and Casadio), Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna (Drs. Raffone, Renzulli, Sanna, Raspollini, Bertoldo, Maletta, Rovero, and Seracchioli), Bologna, Italy
| | - Paolo Casadio
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna (Drs. Raimondo, Raffone, Renzulli, Raspollini, Bertoldo, Maletta, Rovero, Seracchioli, and Casadio), Bologna, Italy
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Barra F, Zorzi C, Albanese M, Stepniewska A, Deromemaj X, De Mitri P, Roviglione G, Clarizia R, Gustavino C, Ferrero S, Ceccaroni M. Ultrasonographic Findings Indirectly Predicting Parametrial Involvement in Patients with Deep Endometriosis: The ULTRA-PARAMETRENDO I Study. J Minim Invasive Gynecol 2023; 30:61-72. [PMID: 36591808 DOI: 10.1016/j.jmig.2022.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE To evaluate ultrasonographic findings as a first-line imaging tool to indirectly predict the presence of parametrial endometriosis (PE) in women with suspected deep endometriosis (DE) undergoing surgery. DESIGN Retrospective analysis of a prospectively collected database (ULTRA-PARAMETRENDO I study; NCT05239871). SETTING Referral center for DE. PATIENTS Consecutive patients undergoing laparoscopic surgery for DE. INTERVENTIONS Preoperative transvaginal ultrasonography was done according to the International Deep Endometriosis Analysis consensus statement. A stepwise forward regression analysis was performed considering the simultaneous presence of DE nodules and the following ultrasonographic indirect signs of DE: diffuse adenomyosis, endometriomas, ovary fixed to the lateral pelvic wall or the uterine wall, absence of anterior/posterior sliding sign, and hydronephrosis. The gold standard for the presence of PE was surgery with histologic confirmation. MEASUREMENTS AND MAIN RESULTS Of 1079 patients, 212 had a surgical diagnosis of PE (left: 18.5%; right: 17.0%; bilateral: 15.9%). The obtained prediction model (χ2 = 222.530; p <.001) for PE included, as independent indirect DE signs presence of hydronephrosis (odds ratio [OR] = 14.5; p = .002), complete absence of posterior sliding sign (OR = 3.3; p <.001), presence of multiple endometriomas per ovary (OR = 3.0; p = .001), and ovary fixation to the uterine wall (OR = 2.4; p <.001); as independent concomitant DE nodules, presence of uterosacral nodules with the largest diameter >10 mm (OR = 3.2; p <.001), presence of rectal endometriosis with the largest diameter >25 mm (OR = 2.3; p = .004), and rectovaginal septum infiltration (OR = 2.3; p = .003). The optimal diagnostic balance was obtained considering at least 2 concomitant DE nodules and at least 1 indirect DE sign (area under the curve 0.75; 95% confidence interval, 0.72-0.79). CONCLUSION Specific indirect ultrasonographic findings should raise suspicion of PE in women undergoing preoperative assessment for DE. The suspicion of parametrial invasion may be critical to address patients to expert leading centers, where proper diagnosis and surgical treatment for PE can be performed.
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Affiliation(s)
- Fabio Barra
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Negrar, Verona (Drs. Barra, Zorzi, Albanese, Stepniewska, Deromemaj, De Mitri, Roviglione, Clarizia, and Ceccaroni); Unit of Obstetrics and Gynecology (Drs. Barra and Gustavino), Genoa, Italy
| | - Carlotta Zorzi
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Negrar, Verona (Drs. Barra, Zorzi, Albanese, Stepniewska, Deromemaj, De Mitri, Roviglione, Clarizia, and Ceccaroni)
| | - Mara Albanese
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Negrar, Verona (Drs. Barra, Zorzi, Albanese, Stepniewska, Deromemaj, De Mitri, Roviglione, Clarizia, and Ceccaroni)
| | - Anna Stepniewska
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Negrar, Verona (Drs. Barra, Zorzi, Albanese, Stepniewska, Deromemaj, De Mitri, Roviglione, Clarizia, and Ceccaroni)
| | - Xheni Deromemaj
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Negrar, Verona (Drs. Barra, Zorzi, Albanese, Stepniewska, Deromemaj, De Mitri, Roviglione, Clarizia, and Ceccaroni)
| | - Paola De Mitri
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Negrar, Verona (Drs. Barra, Zorzi, Albanese, Stepniewska, Deromemaj, De Mitri, Roviglione, Clarizia, and Ceccaroni)
| | - Giovanni Roviglione
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Negrar, Verona (Drs. Barra, Zorzi, Albanese, Stepniewska, Deromemaj, De Mitri, Roviglione, Clarizia, and Ceccaroni)
| | - Roberto Clarizia
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Negrar, Verona (Drs. Barra, Zorzi, Albanese, Stepniewska, Deromemaj, De Mitri, Roviglione, Clarizia, and Ceccaroni)
| | - Claudio Gustavino
- Unit of Obstetrics and Gynecology (Drs. Barra and Gustavino), Genoa, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology (Dr. Ferrero), Genoa, Italy; IRCCS Ospedale Policlinico San Martino, and Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa (Dr. Ferrero), Genoa, Italy.
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Negrar, Verona (Drs. Barra, Zorzi, Albanese, Stepniewska, Deromemaj, De Mitri, Roviglione, Clarizia, and Ceccaroni)
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Di Buono G, Micheli M, Russo G, Vella R, Amato G, Geraci G, Agrusa A. Colorectal infiltrating deep endometriosis: Laparoscopic treatment. A case report. Front Surg 2022; 9:1021944. [PMID: 36406353 PMCID: PMC9669275 DOI: 10.3389/fsurg.2022.1021944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/10/2022] [Indexed: 08/29/2023] Open
Abstract
Endometriosis is a disease affecting approximately 10% of women of fertile age. A particular presentation is deep infiltrating endometriosis of the rectosigmoid colon with symptoms that can mimic an intestinal obstruction or neoplasm. We report the case of a 39-year-old woman with pelvic pain during the menstrual cycle and significant anemia who presented an ectopic endometrial tissue in correspondence of the rectum. Because of the thickness of the lesion the patient underwent a segmental laparoscopic colorectal resection with end-to-end anastomosis.
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Affiliation(s)
- Giuseppe Di Buono
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
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Spagnolo E, Cristóbal Quevedo I, Gortázar de las Casas S, López Carrasco A, Carbonell López M, Pascual Migueláñez I, Hernández Gutiérrez A. Surgeons' workload assessment during indocyanine-assisted deep endometriosis surgery using the surgery task load index: The impact of the learning curve. Front Surg 2022; 9:982922. [PMID: 36132211 PMCID: PMC9483026 DOI: 10.3389/fsurg.2022.982922] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveAssess the surgeons' workload during deep endometriosis surgery after ureteral ICGDesignProspective, consecutive, comparative, single-center studyPopulation41 patients enrolled to deep endometriosis surgery with ureteral ICG from January 2019 to July 2021 at La Paz University HospitalMethodsPatients were divided into 2 groups: patients operated during the learning curve of ureteral ICG instillation and patients operated after the technique was implemented and routinely performed. After surgery, the SURG-TLX form was completed by the surgeons. We evaluated whether a workload reduction occurred.Main outcomes measuresSurgeon's workload was measured using the SURG-TLX form, obtaining the total workload and 6 different dimensions (distractions, temporal demands, task complexity, mental demands, situational stress and physical demands)ResultsA significant positive correlation was found between surgical complexity and situational stress (p = 0.04). Mental demands (p = 0.021), physical demands (p = 0.03), and total workload (p = 0.025) were significantly lower when the technique was routinely performed. The mental demand, physical demands, and total workload perceived by the surgeons at the beginning of the implementation was higher (68 [39–72], 27 [11–46.5], 229 [163–240], respectively) than in the latter ones (40 [9–63], 11.5 [0–32.8], 152 [133.3–213.8], respectively). Distractions appeared to be higher in the latter surgeries (8.5 [0–27.8]) than in the first surgeries (0 [0–7]; p = 0.057).ConclusionsUreter ICG instillation prior to DE surgery significantly reduces the mental and physical demands and total workload of the surgeons in DE surgeries after overcoming the learning curve. Distractions appear to increase as surgical stress decreases.
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Affiliation(s)
- Emanuela Spagnolo
- Department of Gynecology, La Paz University Hospital, Madrid, Spain
- Research Institute, IdiPaz University Hospital, Madrid, Spain
| | - Ignacio Cristóbal Quevedo
- Department of Gynecology, La Paz University Hospital, Madrid, Spain
- Correspondence: Ignacio Cristóbal Quevedo
| | | | - Ana López Carrasco
- Department of Gynecology, La Paz University Hospital, Madrid, Spain
- Research Institute, IdiPaz University Hospital, Madrid, Spain
| | - Maria Carbonell López
- Department of Gynecology, La Paz University Hospital, Madrid, Spain
- Research Institute, IdiPaz University Hospital, Madrid, Spain
| | | | - Alicia Hernández Gutiérrez
- Department of Gynecology, La Paz University Hospital, Madrid, Spain
- Research Institute, IdiPaz University Hospital, Madrid, Spain
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Xie M, Huang X, Zhao S, Chen Y, Zeng X. Effect of Psychological Intervention on Pelvic Floor Function and Psychological Outcomes After Hysterectomy. Front Med (Lausanne) 2022; 9:878815. [PMID: 35547220 PMCID: PMC9081531 DOI: 10.3389/fmed.2022.878815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundHysterectomy is one of the most frequently performed operations worldwide. However, postoperative complications and body image changes may induce psychological distress after hysterectomy. The study aimed to evaluate the effect of psychological intervention on pelvic floor function and psychological outcomes following hysterectomy among patients with benign indications.MethodsNinety-nine patients underwent hysterectomy were randomly divided into intervention group (n = 50) and control group (n = 49). Patients in the control group received routine postoperative nursing care, while extra psychological intervention was provided to patients in the intervention group, including psychological support, regular lectures and family support. After 6 months, patient's psychological statuses were assessed by Generalized Anxiety Disorder scale (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). The pelvic floor function of patients was evaluated using Pelvic Floor Impact Questionnaire (PFIQ-7) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Furthermore, the incidence of postoperative complications, including uracratia, pelvic organ prolapses, sexual dysfunction and chronic pelvic pain, was evaluated.ResultsAfter 6-month intervention, the GAD-7 and PHQ-9 scores were significantly decreased in the intervention group (p < 0.001 and p = 0.018 respectively). Both scored were significantly lower than that in the control group (p < 0.001 and p < 0.001). Compared with control group, the incidence of uracratia, pelvic organ prolapse, sexual dysfunction and chronic pelvic pain for intervention group was significantly lower (p = 0.003, p = 0.027, p = 0.001, p = 0.002 respectively) and the pelvic floor muscle strength was significantly stronger (p = 0.001). Besides, the postoperative Urinary Incontinence Impact Questionnaire (UIQ-7), Pelvic Organ Prolapse Impact Questionnaire (POPIQ-7), and Colorectal-Anal Impact Questionnaire (CRAIQ-7) scores were significantly lower (p = 0.025, p = 0.04, p < 0.001) and PISQ-12 score was significantly higher in intervention group (p < 0.001).ConclusionPsychological intervention could effectively improve the psychological condition of patients with hysterectomy, which may facilitate patients' postoperative recovery in pelvic floor function. These findings emphasized the necessity of psychological intervention in routine postoperative nursing care.
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