{"paper_id":"1176b13d-65a6-40f4-960e-f6dc0ba61068","body_text":"Abstract\nTotal laparoscopic hysterectomy (TLH) in the case of endometriosis may be extremely challenging. It is indicated in patients with deep infiltrative endometriosis (DIE) to treat severe chronic pelvic pain symptoms, heavy menstrual bleeding and adenomyosis recurrences. Before commencing surgery for extensive endometriosis cases, it is vital to conduct a comprehensive preoperative assessment, taking into account the severity of the condition, previous surgical history, and the preferences of the patient. The surgical approach involves meticulous dissection of pelvic structures, including the ureter, medial and lateral para-rectal space, and inferior hypogastric plexus, aiming for a nerve-sparing procedure. Careful dissection in rectovaginal space and dealing with intestinal endometriosis is the mandate of the case.\nThis chapter highlights the role of our Comprehensive Canopy Concept, ‘The 3 Step Technique’ involving a posterior approach for uterine artery ligation, canopy concept for bladder dissection and anterior approach for contralateral uterine artery ligation. The importance of ureteric assessment, dissection, role of ICG and potential stenting in cases of parametrial endometriosis is emphasized.\nAccess this chapter\nTax calculation will be finalised at checkout\nPurchases are for personal use only\nSimilar content being viewed by others\nReferences\nGarcia Garcia JM, Vannuzzi V, Donati C, Bernacchioni C, Bruni P, Petraglia F. Endometriosis: cellular and molecular mechanisms leading to fibrosis. Reprod Sci. 2023;30(5):1453–61. https://doi.org/10.1007/s43032-022-01083-x. Epub 2022 Oct 26. PMID: 36289173; PMCID: PMC10160154.\nAbd El-Kader AI, Gonied AS, Lotfy Mohamed M, Lotfy Mohamed S. Impact of endometriosis-related adhesions on quality of life among infertile women. Int J Fertil Steril. 2019;13(1):72–6. https://doi.org/10.22074/ijfs.2019.5572. Epub 2019 Jan 6. PMID: 30644248; PMCID: PMC6334013.\nSinha R, Sundaram M, Lakhotia S, Hedge A, Kadam P. Total laparoscopic hysterectomy in women with previous cesarean sections. J Minim Invasive Gynecol. 2010;17(4):513–7. https://doi.org/10.1016/j.jmig.2010.03.018.\nDouglass L, Tu F, Senapati S. Anterior cul-de-sac obliteration resulting in acute pain during pregnancy. J Minim Invasive Gynecol. 2012;19(6):S119. https://doi.org/10.1016/j.jmig.2012.08.745.\nLee SY, Koo YJ, Lee DH. Classification of endometriosis. Yeungnam Univ J Med. 2021;38(1):10–8. https://doi.org/10.12701/yujm.2020.00444. Epub 2020 Aug 7. PMID: 32764213; PMCID: PMC7787892.\nLorusso F, Scioscia M, Rubini D, et al. Magnetic resonance imaging for deep infiltrating endometriosis: current concepts, imaging technique and key findings. Insights Imaging. 2021;12:105. https://doi.org/10.1186/s13244-021-01054-x.\nYin S, Lin Q, Xu F, Xu J, Zhang Y. Diagnosis of deep infiltrating endometriosis using transvaginal ultrasonography. Front Med (Lausanne). 2020;7:567929. https://doi.org/10.3389/fmed.2020.567929. PMID: 33330527; PMCID: PMC7719798.\nNezhat C, Li A, Falik R, Copeland D, Razavi GM, Shakib A, Mihailide C, Bamford H, DiFrancesco L, Tazuke S, Ghanouni P, Rivas H, Nezhat A, Nezhat C, Nezhat F. Bowel endometriosis: diagnosis and management. Am J Obstet Gynecol. 2017;218:549. https://doi.org/10.1016/j.ajog.2017.09.023.\nDonnez O. Conservative management of rectovaginal deep endometriosis: shaving should be considered as the primary surgical approach in a high majority of cases. J Clin Med. 2021;10(21):5183. https://doi.org/10.3390/jcm10215183. PMID: 34768704; PMCID: PMC8584847.\nRoman H. Disc excision using transanal circular stapler for deep endometriosis of the rectum in 10 steps. J Minim Invasive Gynecol. 2021;28(1):14–5. https://doi.org/10.1016/j.jmig.2020.04.017. Epub 2020 Apr 23. PMID: 32335183.\nMalzoni M, Rasile M, Coppola M, Iuzzolino D, Casarella L, Di Giovanni A, Falcone F. Totally laparoscopic resection with transanal natural orifice specimen extraction for deep endometriosis infiltrating the rectum. J Minim Invasive Gynecol. 2022;29(1):19. https://doi.org/10.1016/j.jmig.2021.07.015. Epub 2021 Jul 30. PMID: 34333148.\nErekson EA, Martin DK, Ratner ES. Oophorectomy: the debate between ovarian conservation and elective oophorectomy. Menopause. 2013;20(1):110–4. https://doi.org/10.1097/gme.0b013e31825a27ab. PMID: 22929033; PMCID: PMC3514564.\nGuo S-W. Recurrence of endometriosis and its control. Hum Reprod Update. 2009;15(4):441–61. https://doi.org/10.1093/humupd/dmp007.\nKobayashi H, Oda A, Matsuzaki Y, Kondo Y, Hamada Y, Nagashima M, Kobayashi M, Takaki Y, Adachi H. Ureter injury in total laparoscopic hysterectomy. Case Rep Obstet Gynecol. 2023, 2023, 10 pages.:5071080. https://doi.org/10.1155/2023/5071080.\nBoni L, David G, Mangano A, Dionigi G, Rausei S, Spampatti S, Cassinotti E, Fingerhut A. Clinical applications of indocyanine green (ICG) enhanced fluorescence in laparoscopic surgery. Surg Endosc. 2015;29(7):2046–55. https://doi.org/10.1007/s00464-014-3895-x. Epub 2014 Oct 11. PMID: 25303914; PMCID: PMC4471386.\nAlander JT, Kaartinen I, Laakso A, Pätilä T, Spillmann T, Tuchin VV, Venermo M, Välisuo P. A review of indocyanine green fluorescent imaging in surgery. Int J Biomed Imaging. 2012;2012:940585. https://doi.org/10.1155/2012/940585. Epub 2012 Apr 22. PMID: 22577366; PMCID: PMC3346977.\nPg P, Shabnam K, Bhosale SA, et al. Laparoscopic hysterectomy in frozen pelvis—an alternative technique of retrograde adhesiolysis. Gynecol Surg. 2013;10:285–90. https://doi.org/10.1007/s10397-013-0810-8.\nBenoit L, Dabi Y, Bazot M, Thomassin-Naggara I, Ferrier C, Puchar A, Owen C, Touboul C, Darai E, Bendifallah S. Parametrial endometriosis: A predictive and prognostic factor for voiding dysfunction and complications. Eur J Obstet Gynecol Reprod Biol. 2022;276:236–43. https://doi.org/10.1016/j.ejogrb.2022.07.035. Epub 2022 Aug 4. PMID: 35961258.\nTreschan TA, Peters J, Warltier DC. The vasopressin system: physiology and clinical strategies. Anesthesiology. 2006;105:599–612. https://doi.org/10.1097/00000542-200609000-00026.\nModi R. Laparoscopic myomectomy with aquadissection and barbed sutures. J Gynecol Endosc Surg. 2011;2(1):47–52. https://doi.org/10.4103/0974-1216.85283. PMID: 22442536; PMCID: PMC3304286.\nBroughton D, Welling AL, Monroe EH, Pirozzi K, Schulte JB, Clymer JW. Tissue effects in vessel sealing and transection from an ultrasonic device with more intelligent control of energy delivery. Med Devices (Auckl). 2013;6:151–4. https://doi.org/10.2147/MDER.S51663. PMID: 24072978; PMCID: PMC3783500.\nKostov S, Slavchev S, Dzhenkov D, Mitev D, Yordanov A. Avascular spaces of the female pelvis-clinical applications in obstetrics and gynecology. J Clin Med. 2020;9(5):1460. https://doi.org/10.3390/jcm9051460. PMID: 32414119; PMCID: PMC7291144.\nJacob GP, Vilos GA, Al Turki F, Bhangav G, Abu-Rafea B, Vilos AG, Ternamian A. Ureteric injury during gynaecological surgery—lessons from 20 cases in Canada. Facts Views Vis Obgyn. 2020;12(1):31–42. PMID: 32696022; PMCID: PMC7363243.\nLi L, Bi Y, Wang L, et al. Identification and injury to the inferior hypogastric plexus in nerve-sparing radical hysterectomy. Sci Rep. 2019;9:13260. https://doi.org/10.1038/s41598-019-49856-w.\nUccella S, Gisone B, Serati M, Biasoli S, Marconi N, Angeretti G, Gallotta V, Cardinale S, Rausei S, Dionigi G, Scambia G, Ghezzi F. Functional outcomes of nerve-sparing laparoscopic eradication of deep infiltrating endometriosis: a prospective analysis using validated questionnaires. Arch Gynecol Obstet. 2018;298(3):639–47. https://doi.org/10.1007/s00404-018-4852-z. Epub 2018 Jul 30. PMID: 30062386.\nDarwish B, Roman H. Nerve sparing and surgery for deep infiltrating endometriosis: pessimism of the intellect or optimism of the will. Semin Reprod Med. 2017;35(1):72–80. https://doi.org/10.1055/s-0036-1597305. Epub 2016 Dec 12. PMID: 27951614.\nPuntambekar S, Manchanda R. Surgical pelvic anatomy in gynecologic oncology. Int J Gynaecol Obstet. 2018;143(Suppl 2):86–92. https://doi.org/10.1002/ijgo.12616. PMID: 30306582.\nKoh CH. A new technique and system for simplifying total laparoscopic hysterectomy. J Am Assoc Gynecol Laparosc. 1998;5:187–92.\nDonnez J, Jadoul P, Colette S, et al. Deep rectovaginal endometriotic nodules: perioperative complications from a series of 3,298 patients operated on by the shaving technique. Gynecol Surg. 2013;10:31–40. https://doi.org/10.1007/s10397-012-0759-z.\nChoi HJ, Kim MS, Kim TJ. Uterine artery ligation at its origin following retroperitoneal space development decreases blood loss during single-port total laparoscopic hysterectomy. Taiwan J Obstet Gynecol. 2020;59(2):262–8. https://doi.org/10.1016/j.tjog.2020.01.015. PMID: 32127148.\nChaudhry R, Chaudhry K. Anatomy, abdomen and pelvis: uterine arteries. 2023 Sep 4. In: StatPearls [Internet]. Treasure Island: StatPearls Publishing; 2023 Jan–. PMID: 29489202.\nEl-Shawarby S, Salim R, Lavery S, et al. Uterine adherence to anterior abdominal wall after caesarean section. BJOG. 2011;118:1133.\nCrigler B, Zakaria M, Hart S. Total laparoscopic hysterectomy with laparoscopic uterosacral ligament suspension for the treatment of apical pelvic organ prolapse. Surg Technol Int. 2012;22:195–202. PMID: 23225594.\nPalla VV, Karaolanis G, KataFig. 10.Iotis I, Anastasiou I. Ureteral endometriosis: a systematic literature review. Indian J Urol 2017;33(4):276–282. doi: https://doi.org/10.4103/iju.IJU_84_17. PMID: 29021650; PMCID: PMC5635667.\nWeingertner AS, Rodriguez B, Ziane A, Gibon E, Thoma V, Osario F, Haddad C, Wattiez A. The use of JJ stent in the management of deep endometriosis lesion, affecting or potentially affecting the ureter: a review of our practice. BJOG. 2008;115(9):1159–64. https://doi.org/10.1111/j.1471-0528.2008.01795.x. Epub 2008 May 30. PMID: 18518868.\nRozsnyai F, Roman H, Resch B, Dugardin F, Berrocal J, Descargues G, Schmied R, Boukerrou M, Marpeau L, CIRENDO Study Group. Outcomes of surgical management of deep infiltrating endometriosis of the ureter and urinary bladder. JSLS. 2011;15(4):439–47. https://doi.org/10.4293/108680811X13176785203798. PMID: 22643496; PMCID: PMC3340950.\nMelnyk M, Casey RG, Black P, Koupparis AJ. Enhanced recovery after surgery (ERAS) protocols: time to change practice? Can Urol Assoc J. 2011;5(5):342–8. https://doi.org/10.5489/cuaj.11002. PMID: 22031616; PMCID: PMC3202008.\nAuthor information\nAuthors and Affiliations\nEditor information\nEditors and Affiliations\nEthics declarations\nThe author declares no conflict of interest that is relevant to content of this chapter.\nEthical Approval\nInformed consent was obtained from individual participants and patients regarding publication and documentation without disclosing their identity.\nRights and permissions\nCopyright information\n© 2024 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.\nAbout this chapter\nCite this chapter\nJain, N., Srivastava, S., Gulati, D. (2024). Total Laparoscopic Hysterectomy (TLH) in Extensive Endometriosis. In: Jain, N. (eds) Complex Total Laparoscopic Hysterectomy (TLH) with Newer Approaches in Bladder Dissection. Springer, Singapore. https://doi.org/10.1007/978-981-97-3226-5_10\nDownload citation\nDOI: https://doi.org/10.1007/978-981-97-3226-5_10\nPublished:\nPublisher Name: Springer, Singapore\nPrint ISBN: 978-981-97-3225-8\nOnline ISBN: 978-981-97-3226-5\neBook Packages: MedicineMedicine (R0)","source_license":"CC0","license_restricted":false}