Laparoscopic treatment of deeply infiltrating endometriosis with diode laser: a pilot study

Background \nDeep infiltrating endometriosis is defined by the European Society of Human Reproduction and Embryology (ESHRE) \nas a peritoneal infiltration of more than 5 mm deep by the endometrial tissue. DIE frequently presents with nodules \ninvolving the rectovaginal space, the bladder, pelvic nerves, ureters, and/or the bowel and rarely other locations like \nabdominal wall or thorax. Many studies agree that surgical resection of DIE improves pain, quality of life. A wide range \nof surgical procedures may be adopted for the management of DIE in particular to perform excision of nodules from \nureter and bowel. Cold scissor, plasma energy or CO2 lasers have been proposed and it seems that in expert hands \nthey achieve good results and low complications rates. Recently diode lasers have been proposed in endoscopic \ngynecological surgery. The aim of this study was to assess the feasibility, safety and efficacy of the diode laser in the \ntreatment of deep infiltrating endometriosis. \nMethods \nThis Pilot study included 25 women with DE diagnosed in the Endometriosis and Chronic pelvic pain Centre of the \nUniversity of Cagliari between November 2017 and November 2018.Before the surgery they presented following \nsymptoms : pregnancy wish, chronic pelvic pain, dysmenorrhea, dyspareunia, dyschezia, dysuria and 15 of them \nreported previous surgical treatments without employment. Clinical patient characteristics including age, body mass \nindex (BMI), pre-surgical clinical staging, visual analog score for chronic pain measurement, comorbidity, prior \nabdominal surgery, and intraoperative parameters including operative time, blood loss, conversion rate, and \ncomplications were recorded. Postoperative parameters included short-term (within 30 days of the procedure) \ncomplications and length of hospital stay. Complications were measured by the Clavien-Dindo scaleIn detail, during \nthe laparoscopic surgery were performed using the DWLS, with a conic fiber of 1000 micron (Biolitec®, Leonardo®, \nwavelength of 980 nm and 1470 nm): 20 adhesiolysis, 20 uretolysis, 2 ureter stent, 10 cistectomy, 3 high rectosigmoid \nresection (with end-to-end anastomosis) and 15 resection of posterior fornix. \nResults \nMedian patients’ age was 31 (range 22–42), and body mass index was 23 kg/m2 (range 21–33). The mean operative \ntime was 155 min (range 112–175). No intraoperative complications and early complications (< 30 days) occurred, \nand all patients were discharged within 3 days mean ( range 2-8 days) of surgery. Improvement of pain was \nstatistically significative at three months follow-up. \nConclusions \nDiode laser seems to be another useful device for endometriosis treatment. The shaving surgical approach with a \ndiode laser system leads to a safe and effective laparoscopic dissection of deep endometriotic lesions. The results in \nterm of efficacy and pregnancy outcomes need further larger randomized studies.