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

marcello.ceccaroni@sacrocuore.it


DOI: 10.53146/lriog1202140

Abstract

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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Diaphragmatic endometriosis: diagnosis and laparoscopic treatment

Diaphragmatic endometriosis: diagnosis and laparoscopic treatment

Giovanni RoviglioneOrcid, Roberto Clarizia1, Daniele MautoneOrcid, Francesco Bruni1, Matteo Ceccerello1,  Alberto Claudio TerziOrcid, Marcello Ceccaroni1 – Orcid

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

2 – Thoracic Surgery Division, IRCCS “Sacro Cuore – Don Calabria” Hospital, Negrar di Valpolicella, Verona

Corresponding Author: Giovanni Roviglione

giovanni.roviglione@sacrocuore.it


DOI: 10.53146/lriog1202135

Abstract

Diaphragmatic endometriosis (DE) is a rare and often misdiagnosed condition. Most of the times it is asymptomatic and due to the low accuracy of diagnostic tests, it is almost always detected during surgery for pelvic endometriosis. Its management is challenging and, until now, there are not guide-lines about its treatment. In fact, Literature reports a plenty of single-center small series or case-reports about case treated for DE, thus, still nowadays a general consensus for diagnosis or treatment of DE does not exist. However, Our Institution has collected the largest case-series of patient treated for DE, reporting high-effective surgical results and proposing laparoscopy as its ideal tool, for its high cost-benefits relationship and its low morbidity.
A proposal of algorithm for diagnosis and treatment of DE has recently been published by Our Institution with the aim to standardize the surgical appro- ach according to the type of lesion, and finally reducing the rate of under- or over-treatments and intra or post-operative complications.
Conclusions: this kind of surgery should be performed in a Referral Center by a gynecologic surgeon with onco-gynecologic expertise and skills, with the eventual support of a laparoscopic general surgeon, a specialized thoracic surgeon and a trained anesthesiologist.

Keywords: diaphragmatic endometriosis; thoracic endometriosis; extrapelvic endometriosis; laparoscopy; radical surgery.


Available in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283


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