Laparoscopic Resection of Uterosacral Ligaments in Patients with Deeply Infiltrating Endometriosis

Akiyoshi Yamanaka, M. Andou, Keisuke Kodama, A Shirane, Shiori Yanai, S. Nakajima, Mika Fukuda, Shozo Kurotsuchi, K. Ebisawa, Tomonori Hada, Yoshiaki Ota
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2015 · vol. 31(1) , pp. 257–263 · doi:10.5180/jsgoe.31.257 · W2406590707
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

Laparoscopic resection of uterosacral ligaments for deeply infiltrating endometriosis safely reduced pelvic pain and dyspareunia in 262 patients with minimal complications.

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The paper examined laparoscopic resection of uterosacral ligaments for deeply infiltrating endometriosis, aiming to reduce pelvic pain and dyspareunia while addressing surgical risks to the ureter and rectum. Between June 2012 and December 2013, 262 patients underwent the laparoscopic procedure after the ureter and relevant spaces around the ligaments were identified and isolated; outcomes reported included mild dysuria in 3.8% of patients (improving within 2 months), intermittent catheterization in 0.38% (stopped after 14 months), and bilateral hydronephrosis in 0.38% (managed with ureteral dilatation). The authors reported no ureteral or rectal injuries, with a caveat implied by their safety-focused design that results were based on observed perioperative complications rather than a controlled pain-efficacy comparison. This paper is centrally about endometriosis — it evaluates the safety of laparoscopic uterosacral ligament resection for deeply infiltrating endometriosis.

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Abstract

Deeply infiltrating endometriosis (DIE) is defined as subperitoneal invasion by endometriotic lesions. These lesions are considered very active and are strongly associated with pelvic pain. The incidence of DIE is reportedly 20 % in all cases of endometriosis, with uterosacral ligaments representing the most frequent location. Therefore, the resection of uterosacral ligaments is effective in reducing the pelvic pain and dyspareunia that is experienced by patients with endometriosis. However, the operation is associated with a risk of injury to the ureter and rectum; a laparoscopic resection is more useful and safer than open surgery, particularly in patients with adhesion in the pouch of Douglas. Thus, in our study, we initially identified and isolated the ureter and open spaces around the uterosacral ligaments. From June 2012 to December 2013, 262 patients underwent laparoscopic resection of the uterosacral ligaments. Of these, 10 (3.8 %) patients had mild dysuria after the operation, but all cases improved within 2 months. One (0.38 %) patient required clean intermittent catheterization after the operation, which was discontinued 14 months later. Bilateral hydronephrosis occurred in one (0.38 %) patient, which required ureteral dilatation. No ureteral or rectal injury occurred in any patient. Therefore, if the operation is carefully performed, it is possible to safely resect the uterosacral ligaments in patients with endometriosis.
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手術手技 ダグラス窩閉鎖を伴う症例に対する腹腔鏡下仙骨子宮靱帯切除術～合併症を減らす工夫～ 2015 年 31 巻 1 号 p. 257-263 詳細 抄録 Deeply infiltrating endometriosis (DIE) is defined as subperitoneal invasion by endometriotic lesions. These lesions are considered very active and are strongly associated with pelvic pain. The incidence of DIE is reportedly 20 % in all cases of endometriosis, with uterosacral ligaments representing the most frequent location. Therefore, the resection of uterosacral ligaments is effective in reducing the pelvic pain and dyspareunia that is experienced by patients with endometriosis. However, the operation is associated with a risk of injury to the ureter and rectum; a laparoscopic resection is more useful and safer than open surgery, particularly in patients with adhesion in the pouch of Douglas. Thus, in our study, we initially identified and isolated the ureter and open spaces around the uterosacral ligaments. From June 2012 to December 2013, 262 patients underwent laparoscopic resection of the uterosacral ligaments. Of these, 10 (3.8 %) patients had mild dysuria after the operation, but all cases improved within 2 months. One (0.38 %) patient required clean intermittent catheterization after the operation, which was discontinued 14 months later. Bilateral hydronephrosis occurred in one (0.38 %) patient, which required ureteral dilatation. No ureteral or rectal injury occurred in any patient. Therefore, if the operation is carefully performed, it is possible to safely resect the uterosacral ligaments in patients with endometriosis. © 2015 日本産科婦人科内視鏡学会

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