OC16.05: An ultrasound mapping system of pelvic deep infiltrating endometriosis to predict surgical difficulties

Laparoscopic treatment of deep endometriosis is the most challenging surgery for gynecologists. The difficulties of this approach are associate with a quite large number of complications. Presurgical sonographic diagnostic findings are often not comprehensive to the surgeon in order to establish accurate management and counselling of the patients. The aims of the present study was to validate a sonographic mapping system by comparing it to surgical findings and difficulties. 154 patients with pelvic DIE underwent sonographic evaluation prior to laparoscopic surgery, the sonographic mapping was based on a detailed list of locations which described the endometriotic/fibrotic infiltrating tissue in terms of presence or absence, size and infiltration, on different sides of the posterior, lateral and anterior pelvis. The involvement of bowel was described, distinguishing between cranial rectum and caudal rectum and correlated to the need or not to perform a segmental resection. Ureter involvement and correlation with different site of DIE localisation were noted. Posterior DIE alone was found at surgery in 135 patients (87.7%), anterior DIE alone in 2 patient (1.3%), while the association of posterior and anterior DIE lesions were found in 17 patients (11,0%). A significative correlation between the mean operating time and the scoring data showed strict relationship between the score level and the surgical time (51.5 ± 8.6 minutes score ≤ 20; 195.7 ± 62.5 minutes score ≥ 60). Segmental bowel resection was performed in 35 cases, all presented a maximum diameter of the nodule ranging from 3 to 6 cm by TVS. In 39 cases an endometriotic lesion from the ureter was surgical removed. The accuracy of TVS in detecting ureteral involvement was 92.3%. This new ultrasound/surgically mapping system is accurate in mapping the extent of DIE and may be useful for preoperative planning and intraoperative management of symptomatic patients with DIE.