Deep Endometriosis: Less is Better

Errico Zupi, Lucia Lazzeri, Gabriele Centini
Journal of Endometriosis and Pelvic Pain Disorders · 2015 · vol. 7(1) , pp. 1–2 · doi:10.5301/je.5000206 · W1994134024
article OA: closed CC0 ⤵ 8 in-corpus citations
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Accurate diagnosis of deep endometriosis using TVUS and MRI, combined with a multidisciplinary surgical approach by skilled specialists, is crucial for optimal patient management.

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Abstract

many surgeons are considering any opportunity for medical treatment as a possible alternative and effective solution (8). Why? In our opinion and looking at the literature, there are different points to be addressed to better understand if this is a final step or a transitory philosophy. An enormous effort is still in process to enhance the possibility of diagnosing in the best and most accurate way not only the presence but also the size, number and localization of DIE to better counsel patients and guide surgeons. This clinical change is apparently very useful for reducing the number of complications and to inform preoperatively and in details patients scheduled for surgery. A correct diagnosis is fundamental in defining the best treatment strategy for endometriosis. Therefore, noninvasive methods are required to obtain an accurate evaluation of the location and extent of endometriotic lesions, such as transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI). The detection rate of imaging procedures is linked to the experience of the operator. The first-line modality is TVUS, which is deemed to be accurate in detecting both ovarian and extraovarian endometriosis. MRI has shown comparable results with those of TVUS in the assessment of deep endometriosis (9-11). Different authors describes that the dynamic view of the pelvis obtained by TVUS performed by skill operator, allows to give to the surgeons all the informations needed preoperatively by the surgeon. A more strict collaboration among surgeons and diagnosticians is suggested to match the preoperative assessment their experiences. Endometriosis, especially in its more severe expression, needs to be treated by very skilled surgeons able to perform difficult procedures accurately. Surgical treatment must be performed by surgeons dedicated to endometriosis to ensure that a complete treatment is performed while respecting anatomical integrity and reducing the risk of iatrogenic fertility impairment. Moreover, in treating DIE, a multidisciplinary approach is mandatory, which must include general surgeons and urologists, to offer to the patients at the time of the procedure, the best specific skills coming from different specialists in treating DIE (12, 13). Although DIE is a very challenging surgical please introduce it is an expression of benign condition that affects women in their fertile age, and the most aggressive surgical solution and related complication are not always acceptable for the patient. Moreover, knowledge of the pathogenic process behind endometriosis and its symptoms is nowadays clear (14). All of the genetic, immunological and overall endocrinological involvements have been stressed by several authors, achieving a DOI: 10.5301/je.5000206

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endometriosisdie_deep_infiltrating

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