title: Nerve-sparing laparoscopic eradication of deep endometriosis with segmental rectal and parametrial resection: the Negrar method. A single-center, prospective, clinical trial.
abstract: BACKGROUND
  The weight of surgical radicality, together with a lack of anatomical theoretical basis for surgery and inappropriate practical skills, can lead to serious impairments to bladder, rectal, and sexual functions after laparoscopic excision of deep infiltrating endometriosis. Although the "classical" laparoscopic technique for endometriosis excision involving segmental bowel resection has proven to relieve symptoms successfully, it is hampered by several postoperative long-term and/or definitive pelvic dysfunctions.
  
  
  METHODS
  In this prospective cohort study, we compare the laparoscopic nerve-sparing approach to the classical laparoscopic procedure in a series of 126 cases. Satisfactory data for bowel, bladder, and sexual function were considered as primary endpoints.
  
  
  RESULTS
  A total of 126 patients were considered for analysis: 61 treated with nerve-sparing radical excision of pelvic endometriosis with segmental bowel resection (group B), and 65 treated with the classical technique (group A). Intraoperative, perioperative, and postoperative complications were similar between the two groups. Mean days of self-catheterization were significantly lower in the nerve-sparing group (39.8 days) compared with the non-nerve-sparing group (121.1 days; p < 0.001). The relapse rate within 12 months after surgery was comparable between the two groups. Patients of group A suffered from urinary retention more frequently between 1 and 6 months (p = 0.035) compared with group B and did not experience any improvement between 6 months and 1 year (p = 0.018). Overall detection of severe bladder/rectal/sexual dysfunctions was significantly different between the two groups, and 56 patients of group A (86.2%) reported a significantly higher rate of severe neurologic pelvic dysfunctions vs. 1 patient (1.6%) of group B (p < 0.001).
  
  
  CONCLUSIONS
  Our technique appears to be feasible and offers good results in terms of reduced bladder morbidity and apparently higher satisfaction than the classical technique. Considering that this kind of surgery requires uncommon surgical skills and anatomical knowledge, we believe that it should be performed only in selected reference centers.
authors.affiliation: Division of Gynecologic Oncology, International School of Surgical Anatomy, Sacred Heart Hospital, Ospedale Sacro Cuore-Don Calabria, Via Don A.Sempreboni no. 5, 37024 Negrar, VR, Italy. issaschool@gmail.com
authors.forename: Marcello
authors.initials: M
authors.lastname: Ceccaroni
authors.forename: Roberto
authors.initials: R
authors.lastname: Clarizia
authors.forename: Francesco
authors.initials: F
authors.lastname: Bruni
authors.forename: Elisabetta
authors.initials: E
authors.lastname: D'Urso
authors.forename: Maria Lucia
authors.initials: ML
authors.lastname: Gagliardi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Roviglione
authors.forename: Luca
authors.initials: L
authors.lastname: Minelli
authors.forename: Giacomo
authors.initials: G
authors.lastname: Ruffo
mesh_terms: D000714:Anastomosis, Surgical; D002447:Celiac Plexus / Q000601:surgery; D003106:Colon / Q000601:surgery; D004210:Dissection / Q000379:methods; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007001:Hypogastric Plexus / Q000601:surgery; D007431:Intraoperative Complications / Q000517:prevention & control; D010535:Laparoscopy / Q000379:methods*; D008160:Lumbosacral Plexus / Q000601:surgery; D059351:Organ Sparing Treatments / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D012002:Rectal Diseases / Q000517:prevention & control; D012007:Rectum / Q000601:surgery; D012735:Sexual Dysfunction, Physiological / Q000517:prevention & control; D013153:Splanchnic Nerves / Q000601:surgery; D013564:Sympathetic Nervous System / Q000601:surgery; D020196:Trauma, Nervous System / Q000517:prevention & control*; D001745:Urinary Bladder Diseases / Q000517:prevention & control