Extrapolation of the Tinelli's Score for Vascular Involvement in Deep Endometriosis: A Case-Based Perspective

OBJECTIVE: To evaluate the applicability of the Tinelli vascular score, originally developed for gynecologic oncology, as a preoperative risk stratification tool for vascular involvement in deep infiltrating endometriosis (DIE). SETTING: A high-volume tertiary referral center for advanced laparoscopic surgery and deep endometriosis management. PARTICIPANTS: A 44-year-old woman with a history of prior laparoscopic surgery for deep infiltrating endometriosis, presenting with recurrent chronic pelvic pain radiating to the posterior thigh and associated neurosensory symptoms. INTERVENTIONS: Preoperative magnetic resonance imaging demonstrated a recurrent left ovarian endometrioma and fibrotic infiltration of the mesorectal fascia and pelvic sidewall with adherence to the external iliac vessels. Laparoscopic excision was performed using an oncovascular surgical framework extrapolated from the Tinelli vascular classification, with preoperative coordination of a vascular surgery team. CONCLUSION: Although originally designed for oncologic surgery, the Tinelli vascular score may provide valuable guidance when adapted to complex benign conditions such as deep infiltrating endometriosis. Its use facilitates preoperative vascular risk assessment, multidisciplinary surgical planning, and enhanced intraoperative safety in advanced endometriosis surgery. VIDEO ABSTRACT.