Laparoscopic nerve-sparing surgery of deep infiltrating endometriosis: description of the technique and patients’ outcome

Andreas Kavallaris, Kavallaris A, A Kavallaris, Banz C, C. Banz, Chalvatzas N, N. Chalvatzas, A Hornemann, Amadeus Hornemann, Hornemann A, D Luedders, Luedders D, Doerte W. Luedders, K. Diedrich, Diedrich K, Michael K. Bohlmann, M Bohlmann, Bohlmann M
Archives of gynecology and obstetrics · 2010 · vol. 284(1) , pp. 131–135 · doi:10.1007/s00404-010-1624-9 · PMID:20680309 · W2085726244
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-14 ⓘ

This case series described a laparoscopic nerve-sparing technique for deep infiltrating endometriosis, achieving symptom resolution and timely voiding function restoration without long-term bladder dysfunction.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 · read from full text ⓘ

This paper reports a case series of 16 patients undergoing laparoscopic nerve-sparing surgery for deep infiltrating endometriosis involving the rectovaginal septum and/or uterosacral ligaments, describing the procedure for identifying the inferior hypogastric nerve and plexus (single- or double-sided) and comparing outcomes with patients treated using a non-nerve-sparing technique. Postoperatively, dysmenorrhea, pelvic pain, and dyspareunia disappeared in all patients, and voiding function resumed quickly with residual urine volumes <50 ml on two ultrasound measurements. The authors state that identification of the inferior hypogastric nerve and plexus was feasible, and they report no cases of long-term or lifelong bladder self-catheterization, contrasting with the non-nerve-sparing approach, though the study’s size and design as a case series limit generalizability. This paper is centrally about endometriosis — it describes and evaluates laparoscopic nerve-sparing surgery targeting deep infiltrating endometriosis to reduce urinary side effects.

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Abstract

IntroductionThe radical surgery of the deep infiltrating endometriosis of the rectovaginal septum and the uterosacral ligaments with or without bowel resection can cause a serious damage of the pelvic autonomic nerves with urinary retention and the need of self-catheterization.Patients and methodsWe introduce a case series report of 16 patients with laparoscopic nerve-sparing surgery of deep infiltrating endometriosis. We describe the technique step by step and compare the patients' outcome with patients who had undergone a non-nerve-sparing surgical technique. In 12 patients, a double-sided and in four patients, a single-sided identification of the inferior hypogastric nerve and plexus were performed.ResultsIn all patients at least single-sided resection of the uterosacral ligaments were performed. Postoperatively dysmenorrhoea, pelvic pain, and dyspareunia disappeared in all patients. The average operating time was 82 min (range 45-185). Postoperatively, the overall time to resume voiding function was 2 days. The residual urine volume was in all patients <50 ml at two ultrasound measurements.DiscussionIdentification of the inferior hypogastric nerve and plexus was feasible. In comparison with non-nerve-sparing surgical technique, no cases of bladder self-catheterization for a long or even life time was observed, confirming the importance of the nerve-sparing surgical procedure.
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Abstract

Introduction The radical surgery of the deep infiltrating endometriosis of the rectovaginal septum and the uterosacral ligaments with or without bowel resection can cause a serious damage of the pelvic autonomic nerves with urinary retention and the need of self-catheterization. Patients and methods We introduce a case series report of 16 patients with laparoscopic nerve-sparing surgery of deep infiltrating endometriosis. We describe the technique step by step and compare the patients’ outcome with patients who had undergone a non-nerve-sparing surgical technique. In 12 patients, a double-sided and in four patients, a single-sided identification of the inferior hypogastric nerve and plexus were performed.

Results

In all patients at least single-sided resection of the uterosacral ligaments were performed. Postoperatively dysmenorrhoea, pelvic pain, and dyspareunia disappeared in all patients. The average operating time was 82 min (range 45–185). Postoperatively, the overall time to resume voiding function was 2 days. The residual urine volume was in all patients <50 ml at two ultrasound measurements.

Discussion

Identification of the inferior hypogastric nerve and plexus was feasible. In comparison with non-nerve-sparing surgical technique, no cases of bladder self-catheterization for a long or even life time was observed, confirming the importance of the nerve-sparing surgical procedure. Similar content being viewed by others

References

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Condition tags

endometriosisdie_deep_infiltrating

MeSH descriptors

Endometriosis Gynecologic Surgical Procedures Laparoscopy Postoperative Complications Trauma, Nervous System Adult Endometriosis Female Gynecologic Surgical Procedures Gynecologic Surgical Procedures Humans Hypogastric Plexus Hypogastric Plexus Laparoscopy Laparoscopy Postoperative Complications Trauma, Nervous System Trauma, Nervous System Urinary Retention Urinary Retention

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