Efficacy of Targeted Vasopressin Injection at the Recto-Uterine Endometrioid Lesion during Laparoscopic Surgery for Deep Infiltrating Endometriosis: A Randomized Clinical Trial

Fatemeh Davari Tanha, Tanha FD, Feizabad E, Elham Feizabad, Salehi F, Fatemeh Salehi, Mahbod Ebrahimi, Ebrahimi M, Valizadeh A, Akram Valizadeh, Niloofar Poursaadat, Poursaadat N, Behzadi AM, Arezoo Mahin Behzadi, Razieh Mohammadkhani, Mohammadkhani R
Journal of Minimally Invasive Gynecology · 2026 · doi:10.1016/j.jmig.2026.07.030 · PMID:42532203 · W7171856007
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Targeted vasopressin injection during laparoscopic surgery for deep infiltrating endometriosis significantly reduced operative time, bleeding, complications, and improved surgeon satisfaction compared to saline injection.

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Abstract

STUDY OBJECTIVE: To evaluate the efficacy of targeted vasopressin injection at the recto-uterine endometrioid lesion during laparoscopic dissection in patients with deep infiltrating endometriosis (DIE). DESIGN: Double blind randomized clinical trial from January 2023 to January 2024. SETTING: Tertiary university hospital. PATIENTS: Women aged 20-50 years with severe pelvic DIE (stage III/IV, ASRM criteria). INTERVENTIONS: In laparoscopic surgery, in the intervention group, 20 units/mL of vasopressin, diluted in 300 mL of normal saline, was precisely injected into the endometrioid lesions located between the posterior uterus and rectum (retro-uterine DIE nodules). In the control group, an equal volume of saline was injected at the same sites. MEASUREMENTS: Surgical time, intraoperative bleeding, hemoglobin drop, surgical complications, and surgeon satisfaction with anatomical dissection. RESULTS: There was no significant difference between the two groups in demographic characteristics, except for primary infertility. The results of the present study showed that in laparoscopic surgery for pelvic endometriosis, the injection of Vasopressin significantly reduced the duration of the surgery (p=0.016), decreased bleeding and hemoglobin drop (P=0.034), surgery complications (P=0.041), and increased surgeon satisfaction (p<0.001) about the dissection of endometriosis tissue and anatomical differentiation of the pelvic organs compared to saline injection. In addition, 30 and 14 patients in the intervention group and 23 and 8 patients in the control group, respectively, complained of dysmenorrhea and dyspareunia. The findings showed that postoperative dysmenorrhea and dyspareunia in the intervention group decreased to 2 and 2 patients, respectively, and in the control group, they decreased to 2 and 1 patients, respectively. CONCLUSION: Targeted vasopressin injection at the recto-uterine DIE lesion as a simple way facilitates laparoscopic dissection by reducing operative time and bleeding, improving anatomical visualization, and decreasing surgical complications. The study's limitations may have affected the findings; future comprehensive studies are needed to confirm our findings.

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