Role and evolution of nerve-sparing surgery for the treatment of deep infiltrating endometriosis

Role and evolution of nerve-sparing surgery for the treatment of deep infiltrating endometriosis

Marcello CeccaroniOrcid, Roberto Clarizia1, Giovanni Roviglione1, Francesco Bruni1, Daniele MautoneOrcid, Giacomo RuffoOrcid

1 – Department of Obstetrics and Gynecology, Gynecological Oncology and Mini – Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS “Sacro Cuore – Don Calabria” Hospital, Negrar di Valpolicella, Verona

2 – Department of General Surgery, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona

Corresponding Author: Marcello Ceccaroni

DOI: 10.53146/lriog1202140


Nerve-Sparing (NS) surgery is a technique which, in the last decades, has shown to be highly effective in order to significantly reduce intestinal, vesical and sexual dysfunctions without reducing surgical results in eradicating Deep Infiltrating Endometriosis (DIE). Following a correct and standardized anatomo-surgical approach, NS technique for DIE can be reproducible by the pelvic surgeon who desires to face surgery for DIE and can lead, for what is possible in severe cases, to an optimal preservation of the majority of the visceral nerve fibers of the pelvis. This approach has shown not to have a negative impact over recurrence rates, which are similar to those related to the classical technique, such as the rates of efficacy over chronic pelvic pain.

Keywords: deep infiltrating endometriosis; laparoscopy; nerve-sparing; radical surgery; surgical anatomy.

Available in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283

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Regenerative vulvo-vaginal laser

Regenerative vulvo-vaginal laser: when, why, when

Filippo Murina – Orcid

Lower Genital Tract Pathology Service, V. Buzzi Hospital – University of Milan

DOI: 10.53146/lriog1202114


The use of lasers to treat gynaecological conditions including genitourinary syndrome of the menopause (GSM) has become increasingly popular over recent years. The evidence suggests laser therapy may be beneficial as a non-hormonal treatment in GSM. However, we do not know what the optimum treatment regime or interval is or what the role is for sexual hormones either before or in addition to laser treatment. It was demonstrated that a combination regimen of laser and ospemifene may improve clinical effectiveness. Application of the regenerative laser to the vestibule for vulvar pain and dyspareunia is a promising and safe treatment option in postmenopausal women with the use of appropriate parameters. Clinicians need to be aware of the limitations, risks and outcomes of laser therapy as well as the need for careful evaluation of women to ensure appropriate patient selection. Patients also need to be advised and counselled about realistic expectations of outcomes. Indiscriminate treatment of patients with little evaluation and assessment and counselling will lead to poor satisfaction outcomes and morbidity.

Keywords: laser; genitourinary syndrome of the menopause; dyspareunia; vulvar pain.

Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283

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