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The Journal of Obstetrics and Gynecology of India

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05-09-2023 | Endometriosis | Original Article

Endometriosis Resection Using Nerve Sparing Versus Non-nerve Sparing Surgical Techniques

Authors: Shailesh P. Puntambekar, Sneha Venkateswaran, Saranya Naidu, Maitreyee Parulekar, Madhavi Patil, Sravya Inampudi, Mihir Chitale, Suyog Bharambe, Aishwarya Puntambekar, Kshitij Manerikar, Seema Puntambekar

Published in: The Journal of Obstetrics and Gynecology of India | Issue 5/2023

Abstract

Introduction

Endometriosis is the condition in which there are ectopic endometrial tissues outside the uterine cavity. The use of nerve sparing technique has been well established in the field of oncology, leading to better quality of life following radical oncologic procedures without compromising on the long-term survival. The objective of this study is to compare the quality of life in terms of sexual function and urinary function in women undergoing nerve sparing surgeries for endometriosis and those undergoing non-nerve sparing surgeries.

Material and Methods

Data of 51 patients operated for endometriosis at Galaxy Care Laparoscopic Institute, Pune, India between 1st January 2020 till 31st December 2020 were collected and analysed. We included patients in age group between 38 and 44 years in monogamous relationship, with moderate to severe endometriosis (Revised American Society of Reproductive Medicine r-ASRM score of 16 and above 5), being operated for hysterectomy along with ureterolysis and/or bowel resection (including shaving of rectal endometriosis, discoid resection, segmental resection), and excision of large ovarian endometriomas (> 3 cm size) with cul-de-sac obliteration.

Results

The patients were evaluated for the following factors: age, parity, nature of surgery done, immediate intraoperative complications (bowel injury, bladder injury, ureteric injury), operative time in minutes, average blood loss, length of hospital stay, days to removal of foley’s catheter and postoperative urinary and sexual function which were assessed on follow up visit and a 1-year follow up interview. We found that the urinary and sexual function in the group undergoing nerve sparing surgeries was significantly better than the patients undergoing non-nerve sparing surgeries.

Conclusion

Laparoscopic nerve sparing approach for clearance of endometriosis has allowed better quality of life post surgery. Proper understanding and demonstration of pelvic neuroanatomy has made this approach feasible and achievable in carefully selected patients.

Vercellini P, Viganò P, Somigliana E, et al.. Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol. 2014;10(5):261–75. https://doi.org/10.1038/nrendo.2013.255.CrossRefPubMed

Dunselman GA, Vermeulen N, Becker C, et al. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014;29:400–12.CrossRefPubMed

Long Y, Yao DS, Pan XW, et al. Clinical efficacy and safety of nerve-sparing radical hysterectomy for cervical cancer: a systematic review and meta-analysis. PLoS ONE. 2014;9(4):e94116.CrossRefPubMedPubMedCentral

Ballard KD, Seaman HE, de Vries CS, Wright JT. Can symptomatology help in the diagnosis of endometriosis? Findings from a national case-control study—Part 1. BJOG. 2008;115:1382–91.CrossRefPubMed

Canis M, Donnez JG, Guzick DS, Halme JK, et al. Revised American society for reproductive medicine classification of endometriosis: 1996. Fertil Steril. 1997;1997(67):817–21.

Puntambekar S, Shetty TS, Goel A, et al. Single-centre experience of doing safe total laparoscopic hysterectomy: retrospective analysis of 1200 cases. J Obstet Gynaecol India. 2020;70(5):376–83. https://doi.org/10.1007/s13224-020-01333-5.CrossRefPubMedPubMedCentral

Puntambekar SP, Palep RJ, Puntambekar SS, et al. Agarwal GA. Laparoscopic total radical hysterectomy by the Pune technique: our experience of 248 cases. J Minim Invasive Gynecol. 2007;14(6):682–9. https://doi.org/10.1016/j.jmig.2007.05.007.CrossRefPubMed

Puntambekar SP, Lawande A, Puntambekar S, et al. Nerve-sparing radical hysterectomy made easy by laparoscopy. J Minim Invasive Gynecol. 2014;21(5):732. https://doi.org/10.1016/j.jmig.2014.03.020.CrossRefPubMed

Lemos N, Souza C, Marques RM, et al. Laparoscopic anatomy of the autonomic nerves of the pelvis and the concept of nerve-sparing surgery by direct visualization of autonomic nerve bundles. Fertil Steril. 2015;104(5):e11–2. https://doi.org/10.1016/j.fertnstert.2015.07.1138.CrossRefPubMed

10.

Ceccaroni M, Clarizia R, Roviglione G. Nerve-sparing surgery for deep infiltrating endometriosis: laparoscopic eradication of deep infiltrating endometriosis with rectal and parametrial resection according to the Negrar method. J Minim Invasive Gynecol. 2020;27(2):263–4. https://doi.org/10.1016/j.jmig.2019.09.002.CrossRefPubMed

11.

Ceccaroni M, Clarizia R, Bruni F, et al. Nerve-sparing laparoscopic eradication of deep endometriosis with segmental rectal and parametrial resection: the Negrar method. A single-center, prospective, clinical trial. Surg Endosc. 2012;26(7):2029–45. https://doi.org/10.1007/s00464-012-2153-3.CrossRefPubMed

12.

Rabischong B, Botchorishvili R, Bourdel N, et al. Les techniques de préservation nerveuse dans la chirurgie de l’endométriose profonde pour prévenir les séquelles fonctionnelles urinaires et digestives: modalités techniques et résultats. RPC Endométriose CNGOF-HAS [Nerve sparing techniques in deep endometriosis surgery to prevent urinary or digestive functional disorders: techniques and results: CNGOF-HAS Endometriosis Guidelines]. Gynecol Obstet Fertil Senol. 2018;46(3):309–13. https://doi.org/10.1016/j.gofs.2018.02.031.CrossRefPubMed

13.

Fritzer N, Hudelist G. Love is a pain? Quality of sex life after surgical resection of endometriosis review. Eur J Obstet Gynecol Reprod Biol. 2016. https://doi.org/10.1016/j.ejogrb.2016.04.036.CrossRefPubMed

14.

Kossi J, Setala M, Makinen J, et al. Quality of life and sexual function 1 year after laparoscopic rectosigmoid resection for endometriosis. Colorectal Dis. 2013;15:102–8.CrossRefPubMed

15.

Ferrero S, Abbamonte LH, Giordano M, et al. Deep dyspareunia and sex life after laparoscopic excision of endometriosis. Hum Reprod. 2007;22:1142–8.CrossRefPubMed

16.

Abbott JA, Hawe J, Clayton RD, et al. The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2–5 year follow-up. Hum Reprod. 2003;18:1922–7.CrossRefPubMed

Title: Endometriosis Resection Using Nerve Sparing Versus Non-nerve Sparing Surgical Techniques
Authors: Shailesh P. Puntambekar
Sneha Venkateswaran
Saranya Naidu
Maitreyee Parulekar
Madhavi Patil
Sravya Inampudi
Mihir Chitale
Suyog Bharambe
Aishwarya Puntambekar
Kshitij Manerikar
Seema Puntambekar
Publication date: 05-09-2023
Publisher: Springer India
Keywords: Endometriosis
Hysterectomy
Cystectomy
Bladder Injury
Published in: The Journal of Obstetrics and Gynecology of India / Issue 5/2023
Print ISSN: 0971-9202
Electronic ISSN: 0975-6434
DOI: https://doi.org/10.1007/s13224-023-01794-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Endometriosis Resection Using Nerve Sparing Versus Non-nerve Sparing Surgical Techniques

Abstract

Introduction

Material and Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Material and Methods

Results

Conclusion

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