Laparoscopic Excision of Endometriosis

Endometriosis is a benign, gynecologic disease that is defined by the presence of endometrial-like glands and stroma outside of the uterine cavity. The ectopic lesions are often located within the pelvis but may also be located at extra pelvic sites. Surgical intervention with pathologic review of excised lesions remains the gold standard for diagnosis, although advanced imaging can be helpful in identification of deeply infiltrating lesions and assist with surgical planning. Superficial disease can be treated with excision or ablation, with excision being preferred to ensure complete treatment and to obtain pathologic diagnosis. Deeply infiltrating lesions often require extensive dissection for full excision secondary to significant associated scarring and fibrosis. Ovarian endometriomas can be treated with cystectomy or ablation, and considerations should be made for the patient’s desire for future fertility as trauma to ovarian tissue may negatively impact ovarian reserve. Laparoscopic excision of endometriosis is offered when medical management is contraindicated or fails to control symptoms and should be performed by advanced pelvic surgeons given the complex nature of these procedures. Several different techniques have been utilized to safely excise endometriosis depending on the depth of the lesions, organs involved, and patient preference. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others

Shafrir AL, Farland LV, Shah DK, et al. Risk for and consequences of endometriosis: a critical epidemiologic review. Best Pract Res Clin Obstet Gynaecol. 2018;51. https://doi.org/10.1016/j.bpobgyn.2018.06.001. Missmer SA, Hankinson SE, Spiegelman D, Barbieri RL, Marshall LM, Hunter DJ. Incidence of laparoscopically confirmed endometriosis by demographic, anthropometric, and lifestyle factors. Am J Epidemiol. 2004;160(8). https://doi.org/10.1093/aje/kwh275. Eskenazi B, Warner ML. Epidemiology of endometriosis. Obstet Gynecol Clin N Am. 1997;24(2). https://doi.org/10.1016/S0889-8545(05)70302-8. Agarwal SK, Chapron C, Giudice LC, et al. Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol. 2019;220(4). https://doi.org/10.1016/j.ajog.2018.12.039. Nnoaham KE, Hummelshoj L, Webster P, et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril. 2011;96(2). https://doi.org/10.1016/j.fertnstert.2011.05.090. Carter JE. Combined hysteroscopic and laparoscopic findings in patients with chronic pelvic pain. Am Assoc Gynecol Laparosc. 1994;2(1). https://doi.org/10.1016/S1074-3804(05)80830-8. Burney RO, Giudice LC. Pathogenesis and pathophysiology of endometriosis. Fertil Steril. 2012;98(3). https://doi.org/10.1016/j.fertnstert.2012.06.029. Vercellini P, Viganò P, Somigliana E, Fedele L. Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol. 2014;10(5). https://doi.org/10.1038/nrendo.2013.255. Pundir J, Omanwa K, Kovoor E, Pundir V, Lancaster G, Barton-Smith P. Laparoscopic excision versus ablation for endometriosis-associated pain: an updated systematic review and meta-analysis. J Minim Invasive Gynecol. 2017;24(5). https://doi.org/10.1016/j.jmig.2017.04.008. Gordts S, Campo R. Modern approaches to surgical management of endometrioma. Best Pract Res Clin Obstet Gynaecol. 2019;59. https://doi.org/10.1016/j.bpobgyn.2018.12.013. Chen YH, Wang DB, Guo CS. Accuracy of physical examination, transvaginal sonography, magnetic resonance imaging, and rectal endoscopic sonography for preoperative evaluation of rectovaginal endometriosis. Ultrasound Q. 2019;35(1). https://doi.org/10.1097/RUQ.0000000000000428. Guerriero S, Saba L, Pascual MA, et al. Transvaginal ultrasound vs magnetic resonance imaging for diagnosing deep infiltrating endometriosis: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2018;51(5). https://doi.org/10.1002/uog.18961. Feldman MK, VanBuren WM, Barnard H, Taffel MT, Kho RM. Systematic interpretation and structured reporting for pelvic magnetic resonance imaging studies in patients with endometriosis: value added for improved patient care Abdom Radiol. 2020;45(6). https://doi.org/10.1007/s00261-019-02182-1. Treatment of pelvic pain associated with endometriosis: a committee opinion. Fertil Steril. 2014;101(4). https://doi.org/10.1016/j.fertnstert.2014.02.012. Kho RM, Andres MP, Borrelli GM, Neto JS, Zanluchi A, Abrão MS. Surgical treatment of different types of endometriosis: comparison of major society guidelines and preferred clinical algorithms. Best Pract Res Clin Obstet Gynaecol. 2018;51. https://doi.org/10.1016/j.bpobgyn.2018.01.020. Chapron C, Fauconnier A, Goffinet F, Bréart G, Dubuisson JB. Laparoscopic surgery is not inherently dangerous for patients presenting with benign gynaecologic pathology. Results of a meta-analysis. Hum Reprod. 2002;17(5). https://doi.org/10.1093/humrep/17.5.1334. Soto E, Luu TH, Liu X, et al. Laparoscopy vs. Robotic Surgery for Endometriosis (LAROSE): a multicenter, randomized, controlled trial. Fertil Steril. 2017;107. https://doi.org/10.1016/j.fertnstert.2016.12.033. Ahmad G, Baker J, Finnerty J, Phillips K, Watson A. Laparoscopic entry techniques. Cochrane Database Syst Rev. 2019;(1). https://doi.org/10.1002/14651858.CD006583.pub5. Rolla E. Endometriosis: advances and controversies in classification, pathogenesis, diagnosis, and treatment: [Version 1; peer review: 4 approved]. F1000Research. 2019;8. https://doi.org/10.12688/f1000research.14817.1. Jansen RPS, Russell P. Nonpigmented endometriosis: clinical, laparoscopic, and pathologic definition. Am J Obstet Gynecol. 1986;155(6). https://doi.org/10.1016/0002-9378(86)90136-5. Mettler L, Schollmeyer T, Lehmann-Willenbrock E, et al. Accuracy of laparoscopic diagnosis of endometriosis. JSLS: J Soc Laparoendosc Surg/Soc Laparoendosc Surg. 2003;7(1). https://doi.org/10.1016/s1074-3804(03)80032-4. Falcone T, Flyckt-Rebecca R. Clinical management of endometriosis. Obstet Gynecol. 2018;131(3). https://doi.org/10.1097/AOG.0000000000002469. Deckers P, Ribeiro SC, Simões RDS, Miyahara CBDF, Baracat EC. Systematic review and meta-analysis of the effect of bipolar electrocoagulation during laparoscopic ovarian endometrioma stripping on ovarian reserve. Int J Gynecol Obstet. 2018;140(1). https://doi.org/10.1002/ijgo.12338. Ceccaroni M, Clarizia R, Roviglione G. Nerve-sparing surgery for deep infiltrating endometriosis: laparoscopic eradication of deep infiltrating endometriosis with rectal and parametrial resection according to the Negrar method. J Minim Invasive Gynecol. 2020;27(2). https://doi.org/10.1016/j.jmig.2019.09.002. Chou D, Perera S, Condous G, et al. Shaving for bowel endometriosis. J Minim Invasive Gynecol. 2020;27(2). https://doi.org/10.1016/j.jmig.2019.11.012. de Cicco C, Corona R, Schonman R, Mailova K, Ussia A, Koninckx PR. Bowel resection for deep endometriosis: a systematic review. BJOG: Int J Obstet Gynaecol. 2011;118(3). https://doi.org/10.1111/j.1471-0528.2010.02744.x. Shiomi A, Ito M, Saito N, et al. The indications for a diverting stoma in low anterior resection for rectal cancer: a prospective multicentre study of 222 patients from Japanese cancer centers. Color Dis. 2011;13(12). https://doi.org/10.1111/j.1463-1318.2010.02481.x. Leone Roberti Maggiore U, Ferrero S, Candiani M, Somigliana E, Viganò P, Vercellini P. Bladder endometriosis: a systematic review of pathogenesis, diagnosis, treatment, impact on fertility, and risk of malignant transformation [figure presented]. Eur Urol. 2017;71(5). https://doi.org/10.1016/j.eururo.2016.12.015. Chamsy D, King C, Lee T. The use of barbed suture for bladder and bowel repair. J Minim Invasive Gynecol. 2015;22(4). https://doi.org/10.1016/j.jmig.2015.01.030. Andres MP, Arcoverde FVL, Souza CCC, Fernandes LFC, Abrão MS, Kho RM. Extrapelvic endometriosis: a systematic review. J Minim Invasive Gynecol. Published online 2020. https://doi.org/10.1016/j.jmig.2019.10.004. Ciriaco P, Muriana P, Lembo R, Carretta A, Negri G. Treatment of thoracic endometriosis syndrome: a meta-analysis and review. Ann Thorac Surg. Published online 2021. https://doi.org/10.1016/j.athoracsur.2020.09.064. Luna Russo M, Dassel M, Raymond D, Richards E, Falcone T, King C. Considerations for the surgical management of diaphragmatic endometriosis. J Minim Invasive Gynecol. Published online 2020. https://doi.org/10.1016/j.jmig.2020.09.011. Author information Authors and Affiliations Corresponding author Editor information Editors and Affiliations Rights and permissions Copyright information © 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG About this chapter Cite this chapter Carey-Love, A., Luna-Russo, M., King, C.R. (2022). Laparoscopic Excision of Endometriosis. In: Escobar, P.F., Falcone, T. (eds) Atlas of Robotic, Conventional, and Single-Port Laparoscopy. Springer, Cham. https://doi.org/10.1007/978-3-030-93213-8_5 Download citation DOI: https://doi.org/10.1007/978-3-030-93213-8_5 Published: Publisher Name: Springer, Cham Print ISBN: 978-3-030-93212-1 Online ISBN: 978-3-030-93213-8 eBook Packages: MedicineMedicine (R0)