Laparoscopic nerve-sparing surgery of deep infiltrating endometriosis: description of the technique and patients' outcome.
BACKGROUND
The radical surgery of the deep infiltrating endometriosis of the rectovaginal septum and the uterosacral ligaments with or without bowel resection can cause a serious damage of the pelvic autonomic nerves with urinary retention and the need of self-catheterization.


METHODS
We introduce a case series report of 16 patients with laparoscopic nerve-sparing surgery of deep infiltrating endometriosis. We describe the technique step by step and compare the patients' outcome with patients who had undergone a non-nerve-sparing surgical technique. In 12 patients, a double-sided and in four patients, a single-sided identification of the inferior hypogastric nerve and plexus were performed.


RESULTS
In all patients at least single-sided resection of the uterosacral ligaments were performed. Postoperatively dysmenorrhoea, pelvic pain, and dyspareunia disappeared in all patients. The average operating time was 82 min (range 45-185). Postoperatively, the overall time to resume voiding function was 2 days. The residual urine volume was in all patients <50 ml at two ultrasound measurements.


CONCLUSIONS
Identification of the inferior hypogastric nerve and plexus was feasible. In comparison with non-nerve-sparing surgical technique, no cases of bladder self-catheterization for a long or even life time was observed, confirming the importance of the nerve-sparing surgical procedure.
Kavallaris
A
A
Department of Obstetrics and Gynecology, University of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany. andreas.kavallaris@uk-sh.de
Banz
C
C
Chalvatzas
N
N
Hornemann
A
A
Luedders
D
D
Diedrich
K
K
Bohlmann
M
M
D000328:Adult; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007001:Hypogastric Plexus / Q000033:anatomy & histology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D020196:Trauma, Nervous System / Q000209:etiology / Q000517:prevention & control*; D016055:Urinary Retention / Q000209:etiology / Q000517:prevention & control; D055815:Young Adult