title: Laparoscopic nerve-sparing surgery of deep infiltrating endometriosis: description of the technique and patients' outcome.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, University of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany. andreas.kavallaris@uk-sh.de
authors.forename: A
authors.initials: A
authors.lastname: Kavallaris
authors.forename: C
authors.initials: C
authors.lastname: Banz
authors.forename: N
authors.initials: N
authors.lastname: Chalvatzas
authors.forename: A
authors.initials: A
authors.lastname: Hornemann
authors.forename: D
authors.initials: D
authors.lastname: Luedders
authors.forename: K
authors.initials: K
authors.lastname: Diedrich
authors.forename: M
authors.initials: M
authors.lastname: Bohlmann
mesh_terms: 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