Diagnosi e trattamento laparoscopico dell’endometriosi del tratto urinario in un centro di riferimento

Diagnosi e trattamento laparoscopico dell’endometriosi del tratto urinario in un centro di riferimento

Maria Manzone1, Matteo CeccarelloOrcid, Francesco Bruni1, Giovanni RoviglioneOrcid, Roberto ClariziaOrcid, Daniele MautoneOrcid, Giuseppe CaleffiOrcid Alberto MolinariOrcid Marcello Ceccaroni1 – Orcid

1 – Dipartimento per la Tutela della Salute e della Qualità di Vita della Donna, ISSA International School of Surgical Anatomy, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Verona

Autore di riferimento: Maria Manzone

maria.manzone@sacrocuore.it


DOI: 10.53146/lriog1202133

Abstract

The diagnosis of extra-genital Deep Endometriosis is very frequent in referral centers. The urinary tract represents the second most affected extra-genital site. Bladder Endometriosis is defined as Deep Endometriosis infiltrating the detrusor muscle, partially or fully. Ureteral endometriosis is subdivided into intrinsic and extrinsic form, with an obstruction to the spread of parametric Deep Endometriosis. Patients often come to a referral center after a long period of lack of medical therapy and / or several incomplete surgeries. While patients with Bladder Endometriosis are symptomatic, Ureteral Endometriosis is more often low / asymptomatic, leading to progressive and silent renal failure. Having a systematic model of pre-operative diagnosis, an intra-operative evaluation plan using the cooperation of a multi-disciplinary team in a referral center, represents the solution able to reducing the consequences of late diagnosis and offer precise surgical treatment. A complete ultrasound scan (pelvic and abdominal) performed by an experienced operator could allow the diagnosis; second level exams (Magnetic Resonance Imaging, CT urograhy, scintigraphy) can help to confirm and define it. The treatment of Bladder Endometriosis depends on various factors (symptoms, extent of the disease, age of the patients, childbearing desire). In cases of refractory to medical therapy, laparoscopic surgery is the treatment that leads to more complete cure, long-term relief of symptoms and low relapse rates. Any ureteral stenosis caused by an intrinsic lesion requires a ureteral resection. Ureterolysis is the procedure for removing extrinsic ureteral lesions that do not cause direct stenosis, preventing disease progression. An intraoperative evaluation of the ureters after ureterolysis is mandatory to determine the surgical outcome. The laparoscopic nerve-sparing eradication of Deep Endometriosis of the urinary tract is the way to provide good results in terms of symptoms’ control and relapses, an improvement of quality of life with a low post-operative complications rate. The possibility in a reference center to make use of a multidisciplinary team is essential to be the best surgical strategy before and intraoperatively.

Keywords: deep endometriosis; bladder endometriosis; ureteral endometriosis; partial cystectomy; uretero-neocystostomy.


Presente in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283


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Ruolo ed evoluzione della chirurgia nerve-sparing nel trattamento della endometriosi severa

Ruolo ed evoluzione della chirurgia nerve-sparing nel trattamento della endometriosi severa

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

1- Dipartimento di Ostetricia e Ginecologia, Oncologia Ginecologica e Chirurgia Pelvica Mini – Invasiva, International School of Surgical Anatomy, IRCCS Ospedale “Sacro Cuore – Don Calabria”, Negrar di Valpolicella, Verona

2 – Dipartimento di Chiurgia Generale, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Verona

Autore di riferimento: 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.


Presente in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283


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Endometriosi diaframmatica: diagnosi e trattamento laparoscopico

Endometriosi diaframmatica: diagnosi e trattamento laparoscopico

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

1 – Dipartimento di Ostetricia e Ginecologia, Oncologia Ginecologica e Chirurgia Pelvica Mini – Invasiva, International School of Surgical Anatomy, IRCCS Ospedale “Sacro Cuore – Don Calabria”, Negrar di Valpolicella, Verona

2 – Divisione di Chirurgia Toracica, IRCCS Ospedale “Sacro Cuore – Don Calabria”, Negrar di Valpolicella, Verona

Autore di riferimento: 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.


Presente in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283


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Diagnosi e trattamento laparoscopico dell’endometriosi intestinale

Diagnosi e trattamento laparoscopico dell’endometriosi intestinale

Roberto Clarizia1, Giovanni RoviglioneOrcid, Francesco Bruni1, Daniele MautoneOrcid, Carlo Tricolore1, Matteo Ceccerello1, Paola De MitriOrcid, Giacomo RuffoOrcid, Marcello Ceccaroni1 – Orcid

1 – Dipartimento di Ostetricia e Ginecologia, Oncologia Ginecologica e Chirurgia Pelvica Mini- Invasiva, International School of Surgical Anatomy, IRCCS Ospedale “Sacro Cuore – Don Calabria”, Negrar di Valpolicella, Verona

2 – Dipartimento di Chirurgia Generale, IRCCS Ospedale “Sacro Cuore – Don Calabria”, Negrar di Valpolicella, Verona

Autore di riferimento: Roberto Clarizia

roberto.clarizia@sacrocuore.it


DOI: 10.53146/lriog1202134

Abstract

The diagnosis and treatment of intestinal infiltrating endometriosis represents one of the most difficult challenges for an Endometriosis Unit, where such patients should be mandatorily referred. It is a condition that can be both asymptomatic and debilitating the quality of life of affected women, and which intersects with crucial issues such as reproductive desire and pelvic visceral functions. Correct treatment can indeed lead to a significant improvement in the quality of life but is not without long-term risk in terms of rectal, bladder and sexual dysfunctions, as well as peri-operative surgical complications.
The techniques of shaving, discoid resection and segmental resection should not be considered alternatives but distinct and each finds specific indications for specific subsets of patients taking into account on the size of the lesion, the depth of infiltration and patients symptoms.

Keywords: endometriosis; bowel resection; laparoscopy; bowel shaving; discoid resection.


Presente in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283


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