Resection of the posterior vaginal fornix and retrocervical endometriotic lesions in the median part of the pelvis

Kiyohiko Yamada, Chika Nishizawa, Natsuyuki Fujisawa, Masayuki Soda, Hideaki Itoh
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2022 · vol. 38(2) , pp. 246–256 · doi:10.5180/jsgoe.38.2_246 · W4317924095
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This study details a laparoscopic technique for resecting posterior vaginal fornix and retrocervical endometriotic lesions and assesses its efficacy for pain relief.

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

This retrospective observational study evaluated a laparoscopic surgical technique for resecting endometriotic lesions located in the median pelvis, specifically lesions on the posterior vaginal fornix and retrocervical region, using a trapezoidal incision in the median pelvic peritoneum. Among 639 patients who underwent surgery between 2005 and 2016, dysmenorrhea and chronic pelvic pain assessed by 10-cm VAS scores improved substantially after surgery, with 84.6% achieving VAS thresholds below 4 for dysmenorrhea and below 2 for chronic pelvic pain. Complications such as vaginal lacerations and burns occurred in 18 cases without serious organ injury, but pain recurrence was reported in 26.5% of patients. The study’s main limitation is its retrospective design. This paper is centrally about endometriosis—featuring laparoscopic resection of posterior vaginal fornix and retrocervical endometriotic lesions in the median pelvis and its association with pelvic pain outcomes.

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Abstract

Objective: To describe the laparoscopic surgical procedure for the removal of endometriotic lesions in the median part of pelvis and the efficacy of the procedure on pain relief.
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Objective

To describe the laparoscopic surgical procedure for the removal of endometriotic lesions in the median part of pelvis and the efficacy of the procedure on pain relief. Design: Retrospective observational study Setting: A regional medical care support hospital Patients: A total of 639 patients underwent laparoscopic surgery for the removal of endometriotic lesions from 2005 to 2016. Interventions: A trapezoidal incision was made in the median pelvic peritoneum, and the fibrotic lesion was resected from the posterior vaginal fornix and retrocervical region. Main outcome and measures: Pain symptoms were assessed using a 10-cm visual analogue scale (VAS). Recurrence was diagnosed when a patient complained of pelvic pain 100 days after the surgery.

Results

The endometriotic lesions were localized in the medial part of the pelvis. The lesions were resected through a trapezoidal incision in the pelvic peritoneum. Complications including vaginal lacerations and burns were observed in 18 cases, without any serious organ injury. Dysmenorrhea improved from 6.3 ± 2.6 (mean ± SD) to 1.4 ± 2.1, and chronic pelvic pain improved from 3.7 ± 3.0 to 0.2 ± 0.9. In 84.6% of the cases, the VAS level of dysmenorrhea decreased to less than 4 and that of chronic pelvic pain to less than 2 after the surgery. Recurrence of pain was observed in 26.5% of the cases.

Conclusions

Laparoscopic removal of endometriotic lesions from the posterior vaginal fornix and retrocervical region using a trapezoidal incision in the median pelvic peritoneum is feasible without significant complications and is effective in reducing pelvic pain. © 2022 日本産科婦人科内視鏡学会

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