Laparoscopic Dissections for Endometriosis & Pelvic Pain · 21! Surgery in pelvic pain! •...
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Laparoscopic Dissections for Endometriosis & Pelvic Pain Matthew Siedhoff, MD MSCR Associate Professor Minimally Invasive Gynecologic Surgery Cedars-Sinai ® UCLA David Geffen School of Medicine 2 Disclosures • Consultant Applied Medical Olympus Caldera Medical Cooper Surgical
Transcript of Laparoscopic Dissections for Endometriosis & Pelvic Pain · 21! Surgery in pelvic pain! •...
Laparoscopic Dissections for Endometriosis & Pelvic Pain!Matthew Siedhoff, MD MSCR!Associate Professor!Minimally Invasive Gynecologic Surgery!Cedars-Sinai ®!UCLA David Geffen School of Medicine!
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Disclosures!
• Consultant!¡ Applied Medical!¡ Olympus!¡ Caldera Medical!¡ Cooper Surgical!
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Objectives!
• Place endometriosis into the broader context of pelvic pain!• Demonstrate the benefit of excision of ablation of endometriosis!• Learn the anatomy of the avascular retroperitoneal spaces of the pelvis, the ureter, and
the uterine artery as it relates to resection of deeply infiltrating endometriosis!• Show resection of superficial peritoneum involving endometriosis over vital structures
(bladder, ureter, etc.) as well as deep pelvic endometriosis!• Show removal of ovarian endometrioma!• Diagnose and treat urinary and gastrointestinal tract endometriosis!
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Introduction
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Introduction
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“The source of chronic pelvic pain in many women is not solely in the pelvis”!
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The host where the disease manifests is more important
than the disease itself!
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Pelvic pain!
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Pelvic pain!
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Central Sensitization!
Pelvic pain!
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As-Sanie 2013!
Pelvic pain!
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Chronic pain!
Endometriosis!
No pain!
No endometriosis!
As-Sanie 2013!
Pelvic pain!
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Chronic pain!
Endometriosis!
No pain!
No endometriosis!
As-Sanie 2013!
Pelvic pain!
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Chronic pain!
Endometriosis!
No pain!
No endometriosis!
As-Sanie 2013!
Pelvic pain!
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Chronic pain!
Endometriosis!
No pain!
No endometriosis!
As-Sanie 2013!
Pelvic pain!
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As-Sanie 2013!
Pelvic pain!
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The host where the disease manifests is more important
than the disease itself!
Dysmenorrhea: healthy woman!
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pain!
Arachadonic acid!Prostaglandins!
“Severe” dysmenorrhea Chronic Pelvic Pain!
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pain!
Arachadonic acid!Prostaglandins!
Central sensitization!
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excitatory! inhibitory!
chronic pain!
Stratton 2015!
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Surgery in pelvic pain!
• Multifactorial approach to evaluating pain!• Be honest with patients about findings!• Focus on improvement rather than cure!• Delineate what may be helped by surgery and what isn’t likely to be!• Value in “negative” findings in diagnostic surgery!• While surgery (including hysterectomy and removal of ovaries) can be helpful in some
women, the treatment of “chronic pelvic pain” is NOT serial removal of organs!!
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Endometriosis!
Implants! Endometrioma! Deeply infiltrating!
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Endometriosis!
• Not localize well to symptoms!• Clear benefit to surgical treatment!• Surgery > medical treatment!• Medical : prevent recurrence and reduce symptoms!• Excision > ablation!
¡ Decrease pain!¡ Decrease recurrence!¡ Histologic diagnosis!¡ “Tip of the iceberg”!¡ Association with ovarian cancer!
Implants! Hsu 2011, Duffy 2014, Shakiba 2008, Berlanda 2010, Soliman 2017, Somigliana 2014, Guo 2009, Healy 2004, Pundir 2017, Pearce 2012, Munksgaard 2012!
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Endometrioma etiology!
Endometrioma!
• Common phenotype at 20-40% !• Not a true “cyst”!• Hypotheses for formation:!
¡ Forms on the surface and surrounding adhesions promote invagination within the cortex to form cystic lesions!
¡ Metaplasia of surface ovarian epithelium and subsequent invagination!
¡ Implantation of Müllerian epithelium from endometrium or tube onto surface of ovary!
¡ Seeding of hemorrhagic CL (suppression of ovulation reduces recurrence)!
Falcone 2018!
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Endometrioma characteristics!
Endometrioma!
• Cyst wall thickness 1-2mm with variable penetration of endometriosis tissue into surrounding tissue !
¡ Relevant if ablative techniques used!• Intense surrounding inflammation and fibrosis!• Firmly adherent to the cortex and especially deep stroma!• Adherent to uterus, contralateral ovary, rectosigmoid,
ureter, sidewall with often DIE involving adherent peritoneum!
• Implications for pain symptoms, difficulty in removal and challenge distinguishing endometrioma from normal ovary !
Falcone 2018!
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Endometrioma symptoms!
Endometrioma!
• Pain!• Infertility!• Palpable pelvic mass!• Incidental!
Chapron 2009, Chapron 2012!
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Endometrioma symptoms!
Endometrioma!
• Co-existence of DIE more important than the size of cyst!• High rates of concurrent DIE (30-50%) with endometrioma!• For patients with DIE, endometrioma indicates greater number
and severity of DIE lesions!¡ Need to be prepared to also resect all assoc dz to adequately
improve pain sxs. If you just remove the e-oma, only doing half the surgery!
• Repeat surgery common !¡ “Ovarian cystectomy” considered simple, but e-omas are
difficult !¡ DIE isn’t addressed!¡ Experienced with endometriosis surgery because amount of dz
may not always be predictable by imaging or exam!Chapron 2009, Chapron 2012!
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Endometrioma indications for removal!
Endometrioma!
• Pain not controlled medically!• Size!
¡ >3cm ESHRE (European Society of Human Reproduction and Embryology)!
¡ >4cm ASRM (American Society of Reproductive Medicine)!• Eliminate risk of torsion!
¡ Unlikely given surrounding adhesions!• Prevent rupture or infection of endometrioma!• Optimize IVF !
¡ Endometrioma in the way!¡ Avoid infection!
• Pathologic diagnosis!Kennedy 2005, ASRM 2012!
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Endometrioma technique for removal!
Endometrioma!
• Excision favored over drainage or ablative techniques!¡ Improved pain reduction!¡ Reduced risk of recurrence and need for additional surgery!¡ Increased spontaneous pregnancy rate in those prev sub-
fertile !• Vasopressin!• Hemostatic agents and suturing affect AMH less dramatically than
bipolar dessication!!
Hart 2008, Ata 2015!
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Deeply infiltrating endometriosis!
Deeply infiltrating!
• Dense, fibrotic disease which causes adjacent-organ adherence, invasion!• Makes its own estrogen via aromatase!• Can usually be felt on exam or seen on imaging !!• Symptoms!
¡ Dyschezia, hematochezia with bowel disease!¡ Dysuria, hematuria with bladder endometrioma!¡ Dyspareunia and posterior culdesac disease!¡ Subcutaneous abdominal wall endometrioma!¡ Rare: ureteral or bowel obstruction, PTX in thoracic
endometriosis!
Fauconnier 2002!
Deeply infiltrating endometriosis!
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Pararectal space!
Paravesical space!
Vesicovaginal space!
Rectovaginal space!
Retrorectal space!
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Common iliac artery!
External iliac artery!
Medial umbilical ligament!
Uterine artery!
Ureter!
Hypogastric artery!
Rectosigmoid!
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The retroperitoneum is your friend.
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The retroperitoneum is your friend. …Obeys rules …Predictable …Avascular …Keeps you from guessing …Reduces injury …Allows vascular control …Simplifies adhesions …Our diseases don’t go there
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The retroperitoneum is your friend. Do the easy stuff first and the hard stuff gets easier.
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round
external iliac infundibulopelvic
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round
external iliac infundibulopelvic
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umbilical
internal iliac
uterine
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paravesical
pararectal
cardinal
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bladder
cervix
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bladder
cervix
vesicovaginal
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retrorectal
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cervix
rectum
ureter
ureter
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rectovaginal
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rectovaginal
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Urinary tract endometriosis!
• 1% of all patients with endometriosis, 20-50% of those with DIE!¡ Superficial!¡ Bladder endometriomas (80%)!
§ Diagnosis!o Sxs rarely distinguish bladder endo from other DIE!o Hematuria rare, unusual to involve epithelium!o Ultrasound and MRI !o Cystoscopy (exclude malignancy / distance to ureters)!
§ Treatment: partial cystectomy!
Leone 2017, Berlanda 2009, Gabriel 2011, Knabben 2015, Chapron 2003 !
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Urinary tract endometriosis!
• 1% of all patients with endometriosis, 20-50% of those with DIE!¡ Ureteral endometriosis (20%)!
§ 80% of ureteral disease is extrinsic (adventitia)!§ Rarely involves muscularis, submucosa, mucosa!§ Diagnosis!
o Silent, flank pain, incidental, hematuria (rare)!§ Treatment!
o Ureterolysis!o Nodule resection with muscularis repair!o Ureteroureterostomy!o Ureteroneocystotomy !
Alves 2017!
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Gastrointestinal tract endometriosis!
• Intestinal involvement ~10% of women with endometriosis!• 90% = colorectal disease!
¡ Appendix, distal ileum, cecum!• Diagnosis!
¡ Sxs: !§ Cyclic dyschezia, constipation, obstructive diarrhea,
hematochezia (rare) in addition to typical sxs of DIE (dysmenorrhea, dyspareunia, noncyclic pelvic pain, infertility)!
¡ Palpable rectovaginal nodule if low!¡ TVUS with bowel preparation, lower EUS, MRI with rectal
contrast!
Abrão 2015, Seracchioli 2007, Remorgida 2007, Bazot 2017!
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Gastrointestinal tract endometriosis!
• Treatment!¡ Shaving vs discoid resection (manual or
circular stapler) vs segmental resection!§ Skip lesions, >3cm, >40% circumferenceà
segmental resection!§ Conservative surgery may have higher risk of
recurrent sxs, but better functional outcomes and lower risk of complications (e.g. leak)!
Roman 2013, Roman 2018!
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Endometriosis special considerations!
Presacral neurecetomy! Appendectomy! Ovarian remnant!
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Endometriosis special considerations!
Presacral neurecetomy!
• Denervation of superior hypogastric nerve!• Endometriosis + midline component of pain!• RCT: 83% (v 53%) cure rate at 24mos!• Urinary, bowel dysfunction, risks!
Zullo 2004!
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Endometriosis special considerations!
Appendectomy!
• No increased morbidity in GYN surgery!• Excluding appendicitis in Ddx for pts w/ pelvic pain!• Endometriosis (n=400)!
¡ 10% any !¡ 40% deeply infiltrating!¡ Normal-appearing!
• Prevent future emergent appendectomy !¡ Endometriosis: prior surgery, adhesions!
O’Hanlan 2007, Lee 2011, Moulder 2017!
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Endometriosis special considerations!
Appendectomy!
GENERAL GYNECOLOGY
Laparoscopic incidental appendectomy duringlaparoscopic surgery for ovarian endometriomaJung Hun Lee, MD, PhD; Joong Sub Choi, MD, PhD; Seung Wook Jeon, MD; Chang Eop Son, MD;Jong Woon Bae, MD; Jin Hwa Hong, MD; Kyo Won Lee, MD, PhD; Yong Seung Lee, MD
OBJECTIVE: We sought to investigate the safety and efficacy of laparo-scopic incidental appendectomy during laparoscopic surgery forendometrioma.
STUDY DESIGN: We conducted a retrospective study of 356 patientsundergoing laparoscopic surgery for endometrioma with appendec-tomy (appendectomy group, n ! 172) or not (nonappendectomy group,n ! 184). Primary outcome measures were operating time, hemoglo-bin change, hospital stay, return of bowel activity, and any complica-tions. The secondary outcome was appendiceal histopathology.
RESULTS: There were no statistical differences between groups in op-erating time, postoperative changes in hemoglobin concentration, hos-
pital stay, return of bowel activity, or complication rate. Of the 172 re-sected appendices, 52 had histopathologically confirmed abnormalfindings including appendiceal endometriosis in 16.
CONCLUSION: Incidental appendectomy at the time of laparoscopicsurgery for endometrioma does not increase operative morbidity, and ithas considerable diagnostic and preventive value. However, a largeprospective randomized study is needed in the future to confirm thisconclusion.
Key words: appendectomy, endometriosis, laparoscopy
Cite this article as: Lee JH, Choi JS, Jeon SW. Laparoscopic incidental appendectomy during laparoscopic surgery for ovarian endometrioma. Am J Obstet Gynecol2011;204:28.e1-5.
Endometriosis usually involves pelvicstructures, such as the ovaries,
uterosacral ligament, and rectovaginalseptum. Approximately 1–3% of pa-tients with endometriosis reportedlyhave appendiceal endometriosis. In re-cent studies of incidental appendecto-mies performed in patients with endome-triosis accompanying chronic pelvic pain,
right lower quadrant pain, or ovarian en-dometrioma, abnormal pathologies, in-cluding appendiceal endometriosis (13.2–31%), were detected in 34.9-75% of theresected appendices. Based on these re-sults, the studies recommended incidentalappendectomy during the surgical man-agement of endometriosis.1-3
In the obstetric and gynecological fields,there have been several reports of the safetyof incidental appendectomy at the time ofhysterectomy or cesarean delivery.4-6
However, there is no study about the safetyof incidental appendectomy at the time ofsurgery for endometriosis as yet. Further-more, because laparoscopic surgery is be-coming common in the surgical manage-ment of endometriosis with the strikingadvances in laparoscopic surgical tech-niques and instruments,1,7 the safety ofconcurrent laparoscopic appendectomy isanother important issue.
In this study, we compared patientswho had undergone laparoscopic appen-dectomy (appendectomy group) withpatients who had not (nonappendec-tomy group) to investigate the safety andefficacy of laparoscopic incidental ap-pendectomy at the time of laparoscopicsurgery for ovarian endometrioma.
MATERIALS AND METHODSBetween January 2004 and August 2009,356 consecutive women who had under-gone laparoscopic surgery for ovarianendometrioma !3 cm were enrolled inthis retrospective study at Kangbuk Sam-sung Hospital, Seoul, Korea. Patientswith pathologies other than endometri-osis on the histopathological results ofthe ovaries were excluded.
In our institution, laparoscopic inciden-tal appendectomy was preoperatively sug-gested to all patients who were suspected tohave ovarian endometrioma and had nohistory of appendectomy. A laparoscopicappendectomy was conducted with theconsent of the patient; the decision was notinfluenced by abdominal surgical historyor body mass index (BMI).
The subjects were classified into 2groups: the appendectomy group andthe nonappendectomy group. In all, 172patients who had incidental appendec-tomy during the laparoscopic surgerywere assigned to the appendectomygroup, and the nonappendectomy groupenrolled 24 patients with a history ofappendectomy and 160 patients whohad refused to undergo incidentalappendectomy.
From the Department of Obstetrics andGynecology (Drs J. H. Lee, Choi, Jeon, Son,Bae, Hong, and K. W. Lee), KangbukSamsung Hospital, SungkyunkwanUniversity School of Medicine, Seoul, Korea,and the Department of Obstetrics andGynecology (Dr Y. S. Lee), Flushing HospitalMedical Center, Flushing, NY.
Received April 8, 2010; revised July 1, 2010;accepted Aug. 24, 2010.
Reprints: Joong Sub Choi, MD, PhD, Divisionof Gynecologic Oncology and GynecologicMinimally Invasive Surgery, Department ofObstetrics and Gynecology, KangbukSamsung Hospital, Sungkyunkwan UniversitySchool of Medicine, 108 Pyung-dong Jongno-gu, Seoul 110-746 South Korea. [email protected].
0002-9378/$36.00© 2011 Published by Mosby, Inc.doi: 10.1016/j.ajog.2010.08.042
Research www.AJOG.org
28.e1 American Journal of Obstetrics & Gynecology JANUARY 2011
257 Incidental Appendectomies During TotalLaparoscopic Hysterectomy
Katherine A. O’Hanlan, MD, Deidre T. Fisher, MD, Michael S. O’Holleran, MD
ABSTRACTObjective: This retrospective observational report analyzes thedemographics, blood loss, length of surgical duration, numberof days in the hospital, and complications for 821 consecutivepatients undergoing total laparoscopic hysterectomy over a 11-year period stratified by incidental appendectomy.
Methods: A retrospective chart abstraction was per-formed. ANOVA and chi-square tests were performedwith significance preset at P!0.05.
Results: Of 821 consecutive patients undergoing total laparo-scopic hysterectomy, 257 underwent elective appendectomywith the ultrasonic scalpel, either as part of their staging, treat-ment for pelvic pain, or prophylaxis against appendicitis. Com-paring the 2 groups, no difference existed in mean age of50"10 years or mean BMI of 27.6"6.7. Both groups had asimilar mean blood loss of 130 mL. Surgery took less time (137vs 118 minutes, P!0.0012) and the hospital stay was shorter inthe appendectomy group (1.5 vs 1.2, P!0.0001) possibly be-cause it was performed incidentally in most cases. No compli-cations were attributable to the appendectomy, and complica-tion types and rates in both groups were similar. Though allappendicies appeared normal, pathology was documented in9%, including 3 carcinoid tumors.
Conclusions: Incidental appendectomy during totallaparoscopic hysterectomy is not associated with signifi-cant risk and can be routinely offered to patients planningelective gynecologic laparoscopic procedures, as is stan-dard for open procedures.
Key Words: Incidental appendectomy, Laparoscopy, To-tal laparoscopic hysterectomy.
INTRODUCTION
Incidental appendectomy during gynecological proce-dures has been reviewed in the literature since 1967 and isconsidered safe and reasonable during both abdominaland vaginal surgeries.1–8 Nezhat and Nezhat9 reported ontherapeutic laparoscopic appendectomy for the treatmentof pelvic pain and concluded the benefits outweigh theminimal risks. It is not known whether incidental laparo-scopic appendectomy can be done safely and routinely ingynecologic surgery. We reviewed our database of 821cases of total laparoscopic hysterectomy (TLH) in which257 patients had elective appendectomy and report on thesafety of this procedure.
METHODS
We have maintained an anonymous database of TLHcases performed on consecutive patients in each of thefollowing diagnostic categories: benign gynecologic indi-cations and early malignancies limited to Stage IA2 or lesscervical cancer, occult ovarian cancer, and clinical StageIIIA or less endometrial cancer. Investigational ReviewBoard approval is maintained at Sequoia Hospital in Red-wood City, CA, USA. In all of these patients, a simplehysterectomy was performed alone or with other proce-dures as indicated by the patient’s history, physical exam-ination, and radiological examinations. Every surgery wasperformed by the author (KAO’H) from September 5, 1996to April 4, 2007, at 4 California hospitals. A categoricalobstetrics and gynecology resident, a gynecologist, or ageneral surgeon assisted all surgeries.
The technique used for TLH is described elsewhere in thegynecologic literature.10 After the hysterectomy, an ap-pendectomy was performed in 257 patients, incising themesoappendix with a 5-mm Harmonic scalpel or LigaSure(Covidian, Boulder, CO, USA) (Ethicon Endo-Surgery,Cincinnati, OH, USA), to the base at the cecum, thenligating the base with a 0-Vicryl EndoLoop (EthiconSutures, Piscataway, NJ, USA). The appendix was thenincised across the base with the Harmonic scalpel orLigaSure (Figure 1). A ring forceps was passed throughthe vagina to grasp the appendix at the open base andremove it from the abdominal cavity.
Gynecologic Oncology Associates, Palo Alto, California, USA (Dr. O’Hanlan).
Atlanta Center for Special Pelvic Surgery, Atlanta, Georgia, USA (Dr. Fisher).
General Surgery Associates, San Carlos, California, USA (Dr. O’Holleran).
Drs O’Holleran and Fisher have no conflict of interest. Dr. O’Hanlan is a consultantfor Novare Surgical Systems and is a speaker for Ethicon EndoSurgery. No financialsupport was received for this article. No off-label use of any product is discussedor described.
Address reprint requests to: Kate O’Hanlan, MD, Gynecologic Oncology Associates,4370 Alpine Road, Suite 104, Portola Valley, CA 94028, USA. Telephone: 650 8516669, Fax: 650 851 9747, E-mail: [email protected]
© 2007 by JSLS, Journal of the Society of Laparoendoscopic Surgeons. Published bythe Society of Laparoendoscopic Surgeons, Inc.
JSLS (2007)11:428–431428
SCIENTIFIC PAPER
O’Hanlan 2007, Lee 2011, Moulder 2017!
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Endometriosis special considerations!
Ovarian remnant!
• Etiology!¡ Incomplete excision of ovary, usually in adhesive
conditions !§ Endometriosis, PID, IBD, prior surgery!
¡ Cystic enlargement in confined, adherent space!• Symptoms!
¡ Unilateral pain, often cyclic!¡ Lack of menopausal symptoms following bilateral
oophorectomy!
Arden 2011, Kho 2007, Magtibay 2005!
112!
Endometriosis special considerations!
Ovarian remnant!
• Treatment!¡ Surgical excision!¡ Adhesiolysis, ureterolysis, peritonectomy, isolation of
uterine, bowel rsxn!• Prevention!
¡ Always open the pararectal space and skeletonize the IP during oophorectomy!
¡ Divide the IP at level of aortic bifurcation in adhesive conditions!
¡ Mobilize the adherent structures!¡ Clear margins, don’t generously leave ovarian rind on
bowel or sidewall!
Arden 2011, Kho 2007, Magtibay 2005!
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References!
• Falcone T, Flyckt R. Clinical Management of Endometriosis. Obstet Gynecol. 2018 Mar;131(3):557-571.!
• Simoens S, Dunselman G, Dirksen C, Hummelshoj L, Bokor A, Brandes I, et al. The burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centres. Hum Reprod 2012;27:1292–9.!
• Warren JW, Morozov V, Howard FM. Could chronic pelvic pain be a functional somatic syndrome? Am J Obstet Gynecol. 2011 Sep;205(3):199.e1-5.!
• As-Sanie S, Harris RE, Harte SE, Tu FF, Neshewat G, Clauw DJ.Increased pressure pain sensitivity in women with chronic pelvic pain. Obstet Gynecol. 2013 Nov;122(5):1047-55.!
!• Stratton P, Khachikyan I, Sinaii N, Ortiz R, Shah J. Association of chronic pelvic pain and endometriosis
with signs of sensitization and myofascial pain. Obstet Gynecol. 2015 Mar;125(3):719-28.!
• Hsu AL, Sinaii N, Segars J, Nieman LK, Stratton P. Relating pelvic pain location to surgical findings of endometriosis. Obstet Gynecol. 2011 Aug;118:223-30.!
114!
References!
• Duffy JM, Arambage K, Correa FJ, Olive D, Farquhar C, Garry R, et al. Laparoscopic surgery for endometriosis. Cochrane Database Syst Rev. 2014 Apr 3;(4):CD011031.!
• Shakiba K, Bena JF, McGill KM, Minger J, Falcone T. Surgical treatment of endometriosis: a 7 year follow up on the requirement for further surgery. Obstet Gynecol 2008;111(6):1285-92.!
• Berlanda N, Vercellini P, Fedele L. Curr Opin Obstet Gynecol. The outcomes of repeat surgery for recurrent symptomatic endometriosis. 2010 Aug;22(4):320-5.!
• Soliman AM, Du EX, Yang H, Wu EQ, Haley JC. Retreatment Rates Among Endometriosis Patients Undergoing Hysterectomy or Laparoscopy. J Womens Health. 2017 Jun;26(6):644-654.!
• Somigliana E, Vercellini P, Vigano P, Benaglia L, Busnelli A, Fedele L. Postoperative medical therapy after surgical treatment of endometriosis: from adjuvant therapy to tertiary prevention. J Minim Invasive Gynecol. 2014 May-Jun;21(3):328-34!
• Guo SW. Recurrence of endometriosis and its control. Hum Reprod Update. 2009 Jul-Aug;15(4):441-61.!
115!
References!
• Healey M, Cheng C, Kaur H. To excise or ablate endometriosis? A prospective randomized double-blinded trial after 5-year follow-up. J Minim Invasive Gynecol. 2014 Nov-Dec;21(6):999-1004.!
• Pundir J, Omanwa K, Kovoor E, Pundir V, Lancaster G, Barton-Smith P.Laparoscopic Excision Versus Ablation for Endometriosis-associated Pain: An Updated Systematic Review and Meta-analysis. J Minim Invasive Gynecol. 2017 Jul - Aug;24(5):747-756.!
• Pearce CL et al. Association between endometriosis and risk of histological subtypes of ovarian cancer: a pooled analysis of case-control studies. Lancet Oncol 2012; 13(4): 385-94.!
• Munksgaard PS, Blaakaer J. The association between endometriosis and ovarian cancer: a review of histological, genetic and molecular alterations. Gynecol Oncol 2012; 124:164–169.!
• Chapron C, Pietin-Vialle C, Borghese B, Davy C, Foulot H, Chopin N. Associated ovarian endometrioma is a marker for greater severity of deeply infiltrating endometriosis. Fertil Steril. 2009 Aug;92(2):453-7. !
• Chapron C, Santulli P, de Ziegler D, Noel JC, Anaf V, Streuli I, et al. Ovarian endometrioma: severe pelvic pain is associated with deeply infiltrating endometriosis. Hum Reprod 2012;27:702–11.!
116!
References!
• Nisenblat V, Bossuyt PM, Farquhar C, Johnson N, Hull ML. Imaging modalities for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev. 2016 Feb 26;2:CD009591. !
• Van Holsbeke C, Van Calster B, Guerriero S, Savelli L, Leone F, Fischerova D, Czekierdowski A, Fruscio R, Veldman J, Van de Putte G, Testa AC, Bourne T, Valentin L, Timmerman D. Imaging in gynaecology: How good are we in identifying endometriomas? Facts Views Vis Obgyn. 2009;1(1):7-17.!
• Nishida M, Watanabe K, Sato N, Ichikawa Y. Malignant transformation of ovarian endometriosis. Gynecol Obstet Invest. 2000;50 Suppl 1:18-25.!
• Guerriero S, Mais V, Ajossa S, Paoletti AM, Angiolucci M, Melis GB. Transvaginal ultrasonography combined with CA-125 plasma levels in the diagnosis of endometrioma. Fertil Steril, 1996; 65: 293-299. !
• Van Holsbeke C, Van Calster B, Bourne T. External validation of diagnostic models to estimate the risk of malignancy in adnexal masses Clin Cancer Res, 2012; 18: 815-825.!
• Goodman LR, Goldberg JM, Flyckt RL, Gupta M, Harwalker J, Falcone T. Effect of surgery on ovarian reserve in women with endometriomas, endometriosis and controls. Am J Obstet Gynecol; 2016;215:589.e1–6.!
117!
References!
• Hart RJ, Hickey M, Maouris P, Buckett W. Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD004992. !
• Benschop L, Farquhar C, van der Poel N, Heineman MJ. Interventions for women with endometrioma prior to assisted reproductive technology. Cochrane Database Syst Rev. 2010 Nov 10;(11):CD008571.!
• Chen Y, Pei H, Chang Y, Chen M, Wang H, Xie H, Yao S. The impact of endometrioma and laparoscopic cystectomy on ovarian reserve and the exploration of related factors assessed by serum anti-Mullerian hormone: a prospective cohort study. J Ovarian Res. 2014 Nov 26;7:108. !
• Ata B, Uncu G. Impact of endometriomas and their removal on ovarian reserve. Curr Opin Obstet Gynecol. 2015 Jun;27(3):235-41. !
• Vignali M, Mabrouk M, Ciocca E, Alabiso G, Barbasetti di Prun A, Gentilini D, Busacca M. Surgical excision of ovarian endometriomas: Does it truly impair ovarian reserve? Long term anti-Müllerian hormone (AMH) changes after surgery. J Obstet Gynaecol Res. 2015 Nov;41(11):1773-8. !
118!
References!
• Kennedy S, Bergqvist A, Chapron C, D'Hooghe T, Dunselman G, Greb R, Hummelshoj L, Prentice A, Saridogan E; ESHRE Special Interest Group for Endometriosis and Endometrium Guideline Development Group. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod. 2005 Oct;20(10):2698-704.!
• Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility: a committee opinion. Fertil Steril. 2012 Sep;98(3):591-8. !
• Fauconnier A, Chapron C, Dubuisson JB, Vieira M, Dousset B, Bréart G. Relation between pain symptoms and the anatomic location of deep infiltrating endometriosis. Fertil Steril. 2002 Oct;78(4):719-26.!
• Leone Roberti Maggiore U, Ferrero S, Candiani M, Somigliana E, Viganò P, Vercellini P. Bladder Endometriosis: A Systematic Review of Pathogenesis, Diagnosis, Treatment, Impact on Fertility, and Risk of Malignant Transformation. Eur Urol. 2017 May;71(5):790-807.!
• Berlanda N, Vercellini P, Carmignani L, Aimi G, Amicarelli F, Fedele L. Ureteral and vesical endometriosis. Two different clinical entities sharing the same pathogenesis. Obstet Gynecol Surv. 2009 Dec;64(12):830-42. !
119!
References!
• Gabriel B, Nassif J, Trompoukis P, Barata S, Wattiez A. Prevalence and management of urinary tract endometriosis: a clinical case series. Urology. 2011 Dec;78(6):1269-74. !
• Knabben L, Imboden S, Fellmann B, Nirgianakis K, Kuhn A, Mueller MD. Urinary tract endometriosis in patients with deep infiltrating endometriosis: prevalence, symptoms, management, and proposal for a new clinical classification. Fertil Steril. 2015 Jan;103(1):147-52. !
• Chapron C, Fauconnier A, Vieira M, Barakat H, Dousset B, Pansini V, Vacher-Lavenu MC, Dubuisson JB. Anatomical distribution of deeply infiltrating endometriosis: surgical implicationsand proposition for a classification. Hum Reprod. 2003 Jan;18(1):157-61.!
• Alves J, Puga M, Fernandes R, Pinton A, Miranda I, Kovoor E, Wattiez A. J Minim Invasive Gynecol. 2017 Mar - Apr;24(3):466-472. Laparoscopic Management of Ureteral Endometriosis and Hydronephrosis Associated With Endometriosis.!
• Abrão MS, Petraglia F, Falcone T, Keckstein J, Osuga Y, Chapron C. Deep endometriosis infiltrating the recto-sigmoid: critical factors to consider before management. Hum Reprod Update. 2015 May-Jun;21(3):329-39.!
120!
References!
• Seracchioli R Poggioli G Pierangeli F Manuzzi L Gualerzi B Savelli L Remorgida V Mabrouk M Venturoli S. Surgical outcome and long-term follow up after laparoscopic rectosigmoid resection in women with deep infiltrating endometriosis. BJOG 2007;114:889–895.!
• Remorgida V, Ferrero S, Fulcheri E, Ragni N, Martin DC. Bowel endometriosis: presentation, diagnosis, and treatment. Obstet Gynecol Surv 2007;62:461–470. !
• Bazot M, Daraï E. Diagnosis of deep endometriosis: clinical examination, ultrasonography, magnetic resonance imaging, and other techniques.Fertil Steril. 2017 Dec;108(6):886-894 !
• Roman H, Vassilieff M, Tuech JJ, Huet E, Savoye G, Marpeau L, Puscasiu L. Postoperative digestive function after radical versus conservative surgical philosophy for deep endometriosis infiltrating the rectum. Fertil Steril 2013; 99:1695– 1704.!
• Roman H, Bubenheim M, Huet E, Bridoux V, Zacharopoulou C, Daraï E, Collinet P, Tuech JJ. Conservative surgery versus colorectal resection in deep endometriosis infiltrating the rectum: a randomized trial. Hum Reprod. 2018 Jan 1;33(1):47-57. !
121!
References!
• Zullo F, Palomba S, Zupi E, Russo T, Morelli M, Sena T, Pellicano M, Mastrantonio P. Long-term effectiveness of presacral neurectomy for the treatment of severe dysmenorrhea due to endometriosis. J Am Assoc Gynecol Laparosc. 2004 Feb;11(1):23-8.!
• O'Hanlan KA, Fisher DT, O'Holleran MS. 257 incidental appendectomies during total laparoscopic hysterectomy. JSLS. 2007 Oct-Dec;11(4):428-31.!
• Lee JH, Choi JS, Jeon SW, Son CE, Bae JW, Hong JH, Lee KW, Lee YS. Laparoscopic incidental appendectomy during laparoscopic surgery for ovarian endometrioma. Am J Obstet Gynecol. 2011 Jan;204(1):28.e1-5. !
• Moulder JK, Siedhoff MT, Melvin KL, Jarvis EG, Hobbs KA, Garrett J. Risk of appendiceal endometriosis among women with deep-infiltrating endometriosis. Int J Gynaecol Obstet. 2017 Nov;139(2):149-154. !
• Arden D, Lee T. Laparoscopic excision of ovarian remnants: retrospective cohort study with long-term follow-up. J Minim Invasive Gynecol 2011; 18:194–199.!
122!
References!
• Kho RM, Magrina JF, Magtibay PM. Pathologic findings and outcomes of a minimally invasive approach to ovarian remnant syndrome. Fertil Steril 2007; 87:1005–1009.!
• Magtibay PM, Nyholm JL, Hernandez JL, Podratz KC. Ovarian remnant syndrome. Am J Obstet Gynecol 2005; 193:2062–2066.!
