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1
Davydov, A. I., L. M. Mikhaleva, M. B. Khabarova, R. A. Chilova, and V. A. Lebedev. "Endometrioid cystadenoma – deep ovarian endometriosis." Voprosy ginekologii, akušerstva i perinatologii 21, no. 3 (2022): 130–37. http://dx.doi.org/10.20953/1726-1678-2022-3-130-137.
Анотація:
Among all endometriosis lesions of female reproductive organs, ovarian endometrioma is the most discussed nosology. Since 2014, ovarian endometrioid cysts have been classified as benign tumors (WHO Classification of Tumours of Female Reproductive Organs, 4th edition). In 2021, the 11th revision of the International Classification of Diseases (ICD-11) was amended, according to which the term “endometrioid ovarian cyst” (from 2018 to 2021 – heading GA18.3 Ovarian endometriotic cyst, section GA18 Acquired abnormalities of ovary) is no longer used, and the clinical and morphological signs of these cysts are presented in the heading GA10.B5 Deep ovarian endometriosis. In 2020, WHO updated the histological classification of female genital tumors (Female Genital Tumours WHO Classification of Tumours, 5th Edition), in which the section “endometrioid tumors” is presented only with endometrioid cystadenoma and endometrioid adenofibroma without mentioning the endometrioid cyst, but in accordance with the ICD-11, endometrioid cystadenoma is coded as “GA10.B5 Deep ovarian endometriosis”. Thus, on the one hand, ovarian endometrioma is a neoplastic process and requires appropriate approaches when choosing treatment tactics, on the other hand, cystectomy for endometrioma is accompanied by a pronounced loss of ovarian reserve. A possible consensus in this problem seems to be a minimally invasive method in the treatment of patients with ovarian endometriomas – ethanol sclerotherapy with cytological examination of the aspirate obtained from the neoplasm. The effectiveness of sclerotherapy largely depends on the choice of postoperative hormonal therapy. Today, dienogest is considered to be the most effective “anti-endometrioid” progestogen. However, there is an erroneous opinion that ethinylestradiol neutralizes the antiproliferative effect of dienogest and stimulates the growth of endometriosis. On the contrary, ethinylestradiol enhances the inhibitory effect of progestogen on the growth of ovarian endometrioma cells. Key words: endometrioid cystadenoma, ovarian endometrioma, deep ovarian endometriosis, sclerotherapy, dienogest
2
Knez, Jure, Andraž Dovnik, Maja Pakiž, Igor But, Milan Reljič, Vida Gavrić Lovrec, Maja Banović, and Iztok Takač. "Contemporary approach to diagnostics in women with suspected pelvic endometriosis." Acta Medico-Biotechnica 12, no. 2 (November 29, 2021): 10–20. http://dx.doi.org/10.18690/actabiomed.182.
Анотація:
Endometriosis is a common chronic female reproductive system disease, characterised by the presence of endometrial tissue outside the endometrium and myometrium. It can severely compromise quality of life and have an impact on fertility. Although advances in conservative medical treatment options have been made, surgery is often a necessary part of treatment for this insidious disease.Historically, it was believed that only ovarian endometriosis could be diagnosed non-invasively by an ultrasound examination, while endometriosis at other locations could not be observed. With advances in imaging techniques over the last decades, this has changed dramatically and today deep pelvic endometriosis can be diagnosed non-invasively with high sensitivity and specificity. The aim of this review is to evaluate the contribution of clinical examination, laparoscopy, and non-invasive imaging techniques, mainly transvaginal ultrasound and magnetic resonance imaging, to diagnose deep pelvic endometriosis.Evidence shows that transvaginal ultrasound with high-quality equipment in experienced hands offers high diagnostic accuracy for deep pelvic endometriosis diagnosis. Comprehensive ultrasound examination should be used as a first-line method of choice in diagnostics of women with suspected endometriosisand chronic pelvic pain.
3
Berlanda, Nicola, Laura Benaglia, Lara Bottelli, Chiara Torri, Andrea Busnelli, Edgardo Somigliana, and Paolo Vercellini. "The impact of IVF on deep invasive endometriosis." European Journal of Obstetrics & Gynecology and Reproductive Biology: X 4 (October 2019): 100073. http://dx.doi.org/10.1016/j.eurox.2019.100073.
4
Baușic, Alexandra, Ciprian Coroleucă, Cătălin Coroleucă, Diana Comandașu, Roxana Matasariu, Andrei Manu, Francesca Frîncu, Claudia Mehedințu, and Elvira Brătilă. "Transvaginal Ultrasound vs. Magnetic Resonance Imaging (MRI) Value in Endometriosis Diagnosis." Diagnostics 12, no. 7 (July 21, 2022): 1767. http://dx.doi.org/10.3390/diagnostics12071767.
Анотація:
(1) Background: Endometriosis is a widespread gynecological condition that causes chronic pelvic discomfort, dysmenorrhea, infertility, and impaired quality of life in women of reproductive age. Clinical examination, transvaginal ultrasonography (TVS), and magnetic resonance imaging (MRI) are significant preoperative non-invasive diagnosis procedures for the accurate assessment of endometriosis. Although TVS is used as the primary line for diagnosis, MRI is commonly utilized to achieve a better anatomical overview of the entire pelvic organs. The aim of this systematic review article is to thoroughly summarize the research on various endometriosis diagnosis methods that are less invasive. (2) Methods: To find relevant studies, we examined electronic databases, such as MEDLINE/PubMed, Cochrane, and Google Scholar, choosing 70 papers as references. (3) Results: The findings indicate that various approaches can contribute to diagnosis in different ways, depending on the type of endometriosis. For patients suspected of having deep pelvic endometriosis, transvaginal sonography should be the first line of diagnosis. Endometriosis cysts are better diagnosed with TVS, whereas torus, uterosacral ligaments, intestine, and bladder endometriosis lesions are best diagnosed using MRI. When it comes to detecting intestine or rectal nodules, as well as rectovaginal septum nodules, MRI should be the imaging tool of choice. (4) Conclusions: When diagnosing DE (deep infiltrative endometriosis), the examiner’s experience is the most important criterion to consider. In the diagnosis of endometriosis, expert-guided TVS is more accurate than routine pelvic ultrasound, especially in the deep infiltrative form. For optimal treatment and surgical planning, accurate preoperative deep infiltrative endometriosis diagnosis is essential, especially because it requires a multidisciplinary approach.
5
Mabrouk, M., S. Mahgoub, A. Vashisht, and R. Seracchioli. "Innovative Cadaveric Technique: Utilising n-Butyl Cyanoacrylate (n-BCA) for Deep Endometriosis Excision Simulation in Minimal Invasive Surgery Training." Facts, Views and Vision in ObGyn 16, no. 1 (March 2024): 83–85. http://dx.doi.org/10.52054/fvvo.16.1.002.
Анотація:
Background: Our study aimed to create a novel technique using n-butyl cyanoacrylate (n-BCA) for minimal access simulation training on cadavers in deep endometriosis excision. Objectives: A step-by-step video demonstration of using n-BCA in cadavers to simulate deep endometriosis. This technique is integrated into training sessions using cadavers aimed at enhancing surgical proficiency for deep endometriosis procedures. Material and Methods: Video article describing using n-BCA in cadavers as a simulation model. Result: This technique has been used in a hands-on cadaveric training course, and positive feedback supports the recommendation to incorporate this technique. Conclusion: Utilizing a human cadaver model proves beneficial for enhancing understanding of deep pelvic innervation. Implementing n-BCA in these cadaver dissections demonstrates both reproducibility and safety. This approach significantly contributes to refining surgical expertise in the excision of deep infiltrating endometriosis.
6
Sparic, Radmila, Gernot Hudelist, and Joerg Keckstein. "Diagnosis and treatment of deep infiltrating endometriosis with bowel involvement: A case report." Srpski arhiv za celokupno lekarstvo 139, no. 7-8 (2011): 531–35. http://dx.doi.org/10.2298/sarh1108531s.
Анотація:
Introduction. Deep infiltrating endometriosis is a form of endometriosis penetrating deeply under the peritoneal surface causing pain and infertility. Assessment of the pelvis by laparoscopy and histological confirmation of the disease is considered the golden standard of diagnosis. Case Outline. We are presenting a patient diagnosed with deep infiltrating endometriosis by transvaginal ultrasound and treated with minimally invasive radical surgery including segmental resection of the bowel. Conclusion. Transvaginal sonography has an important role in detecting deep endometriosis of the pelvis. Fertility sparing surgery is the treatment of choice in symptomatic women wishing to retain fertility, since drugs used for endometriosis interfere with ovulation. The success of the surgery depends on the accuracy of the preoperative diagnosis. A multidisciplinary approach in managing deep endometriosis is mandatory in order to offer patients the best possible treatment using the combined skills of the colorectal and gynaecologic surgical teams. The presented case exhibits the feasibility of laparoscopic approach to severe pelvic endometriosis with bowel involvement.
7
Arkfeld, Christopher, Julia Gelissen, Animesh Upadhyay, and Gary Altwerger. "Deep infiltrating endometriosis with mucinous metaplasia of mullerian origin." Journal of Endometriosis and Pelvic Pain Disorders 15, no. 2 (June 2023): 91–94. http://dx.doi.org/10.1177/22840265231178332.
Анотація:
Background: Endometriosis is a common gynecological condition that often presents with pelvic pain and infertility, but in rare cases may masquerade as a gastrointestinal or gynecologic malignancy. Case: A 49-year-old G0 presented with abdominal pain, fevers, elevated tumor markers, and a large adnexal mass concerning for malignancy. Intra-operatively, mucinous lesions diffusely involved abdominopelvic structures. Intra-operative frozen section (IOFS) revealed invasive cancer and full cytoreductive surgery was completed. Final pathology was downgraded to atypical cystic endometriosis with mucinous metaplasia. Conclusion: Endometriosis, a nonmalignant condition, can present as pelvic masses associated with elevated tumor markers. The case presented here depicts a confounding preoperative and intraoperative picture where endometriosis was falsely identified as malignancy. Endometriosis should always remain a part of the differential diagnosis in a premenopausal patient with presumed gastrointestinal or gynecologic malignancies.
8
Dewanto, Agung, Muhammad Dimas Reza Rahmana, Regina Arumsari, Nurida Khasanah, Wicesa Nugraha, Vanessa Trizia, and Khoiruddin Anshori. "#125 : The Role of BDNF Receptors in the Incidence of Endometrioma Tissue Invasion Onto the Chorioallantoic Membrane." Fertility & Reproduction 05, no. 04 (December 2023): 629–30. http://dx.doi.org/10.1142/s2661318223743618.
Анотація:
Background and Aims: Previous studies have explored the role of neurotrophins and their receptors, especially in forming deep endometriosis, endometriosis tissue invasion, and its effects on tissue proliferation. However, these studies do not include research on the pathogenesis of endometriomas. We tried to model the invasion of endometrioma tissue to find out more about its pathogenesis by using the chorioallantoic membrane (CAM) as the host. Immunohistochemistry (IHC) to detect neurotrophin BDNF and its receptors, namely TrkB and P75, are employed and linked between their expression and the process of invasion and proliferation. Method: The endometriotic tissue samples were collected from women (n=27) who underwent hysteroscopy/laparoscopy at Dr. Sardjito Central Hospital. Peritoneal endometriosis (PE) lession, endometrioma (CC), and eutopic endometrium (EN) was analyzed with 15 tissue samples in each group. Samples were placed in a tube containing transport medium and transplanted into CAM of fertile chicken eggs for five days. Transplanted tissue was harvested, and histological preparations were made using the paraffin method. IHC staining was performed on p75, Ki67, TrkB, and BDNF staining. Invasion analysis and IHC evaluation were performed with a semi-quantitative method. Data were analyzed using IBMⓇ SPSS Statistics version 25.0. Statistical significance was accepted at P < 0.05. Results: Normal Endometrium expressed the highest expression of BDNF than peritoneal endometriosis and endometrioma (0.36± 0.38, 0.16± 0.13, 0.07± 0.07, P=0.007). The P75 expression correlated positively with Ki67 expression in PE and CC samples (P=0.012; P=0.008). Conclusion: The p75 receptor may have a role in endometriosis tissue proliferation, but this receptor does not directly influence tissue invasion into CAM. While proliferation in endometriomas positively correlates with invasion into CAM, it is not correlated with peritoneal endometriosis.
9
Ćorić, Mario, Marija Gregov, Marko Jakov Šarić, Mislav Mikuš, Franjo Grgić, Nikola Knežević, Petar Matošević, and Ivo Brozović. "One-stage, radical laparoscopic endometriosis excision involving three different organ systems: A case report from tertiary referral center." Journal of Endometriosis and Pelvic Pain Disorders 12, no. 3-4 (June 15, 2020): 115–19. http://dx.doi.org/10.1177/2284026520928246.
Анотація:
Introduction: We present a case of an extensive endometriosis involving left paracolpium and left parametrium, rectovaginal septum, urinary bladder, left interiliac region between artery and vein, left ureter and rectum, presenting as dysmenorrhoea, alternating bouts of diarrhea and constipation and hydronephrosis. Methods: Laparoscopic surgery made by a multidisciplinary team consist of gynecologic, abdominal surgeon and urologist. Results: Successfully managed deep infiltrated endometriosis. Conclusion: The aim of this report is to demonstrate benefit of one-stage, minimally invasive radical surgical procedure performed in a tertiary referral center. To the best of our knowledge, this report presents an extremely complex case because we successfully managed deep infiltrating endometriosis in three different organ systems at the same time, using minimally invasive nerve-sparing technique. A case with the same constellation has not been published yet since reported cases of extrapelvic endometriosis chiefly address one organ system involvement.
10
Daniilidis, Angelos, Georgios Grigoriadis, Dimitra Dalakoura, Maurizio N. D’Alterio, Stefano Angioni, and Horace Roman. "Transvaginal Ultrasound in the Diagnosis and Assessment of Endometriosis—An Overview: How, Why, and When." Diagnostics 12, no. 12 (November 23, 2022): 2912. http://dx.doi.org/10.3390/diagnostics12122912.
Анотація:
Endometriosis is a common gynaecological disease, causing symptoms such as pelvic pain and infertility. Accurate diagnosis and assessment are often challenging. Transvaginal ultrasound (TVS), along with magnetic resonance imaging (MRI), are the most common imaging modalities. In this narrative review, we present the evidence behind the role of TVS in the diagnosis and assessment of endometriosis. We recognize three forms of endometriosis: Ovarian endometriomas (OMAs) can be adequately assessed by transvaginal ultrasound. Superficial peritoneal endometriosis (SUP) is challenging to diagnose by either imaging modality. TVS, in the hands of appropriately trained clinicians, appears to be non-inferior to MRI in the diagnosis and assessment of deep infiltrating endometriosis (DIE). The IDEA consensus standardized the terminology and offered a structured approach in the assessment of endometriosis by ultrasound. TVS can be used in the non-invasive staging of endometriosis using the available classification systems (rASRM, #ENZIAN). Given its satisfactory overall diagnostic accuracy, wide availability, and low cost, it should be considered as the first-line imaging modality in the diagnosis and assessment of endometriosis. Modifications to the original ultrasound technique can be employed on a case-by-case basis. Improved training and future advances in ultrasound technology are likely to further increase its diagnostic performance.
11
Seracchioli, Renato, Linda Manuzzi, Mohamed Mabrouk, Serena Solfrini, Clarissa Frascà, Fabio Manferrari, Filippo Pierangeli, Roberto Paradisi, and Stefano Venturoli. "A multidisciplinary, minimally invasive approach for complicated deep infiltrating endometriosis." Fertility and Sterility 93, no. 3 (February 2010): 1007.e1–1007.e3. http://dx.doi.org/10.1016/j.fertnstert.2009.09.058.
12
Vigueras, Smith A., R. Cabrera, MT Zomer, and W. Kondo. "2934 Minimally Invasive Treatment of Bladder Deep Endometriosis and Isthmocele." Journal of Minimally Invasive Gynecology 26, no. 7 (November 2019): S172. http://dx.doi.org/10.1016/j.jmig.2019.09.314.
13
Konrad, Lutz, Lea M. Fruhmann Berger, Veronica Maier, Fabian Horné, Laura M. Neuheisel, Elisa V. Laucks, Muhammad A. Riaz, Frank Oehmke, Ivo Meinhold-Heerlein, and Felix Zeppernick. "Predictive Model for the Non-Invasive Diagnosis of Endometriosis Based on Clinical Parameters." Journal of Clinical Medicine 12, no. 13 (June 23, 2023): 4231. http://dx.doi.org/10.3390/jcm12134231.
Анотація:
Objectives: Are other pain symptoms in addition to dysmenorrhea, dyspareunia, dyschezia, dysuria, and chronic pelvic pain correlated to endometriosis and suitable for a clinical prediction model? Methods: We conducted a prospective study from 2016 to 2022, including a total of 269 women with numerous pain symptoms and other parameters. All women filled out two questionnaires and were examined by palpation and transvaginal ultrasound (TVUS). In cases of suspected deep endometriosis, magnetic resonance imaging (MRI) was performed. After the operation, endometriosis was diagnosed by histological examination. Results: All in all, 30 significant parameters and 6 significant numeric rating scale (NRS) scores associated with endometriosis could be identified: 7 pain adjectives, 8 endometriosis-associated pain symptoms, 5 pain localizations, 6 parameters from the PainDETECT, consumption of analgesics, and allergies. Furthermore, longer pain duration (before, during, and after menstruation) was observed in women with endometriosis compared to women without endometriosis (34.0% vs. 12.3%, respectively). Although no specific pain for endometriosis could be identified for all women, a subgroup with endometriosis reported radiating pain to the thighs/legs in contrast to a lower number of women without endometriosis (33.9% vs. 15.2%, respectively). Furthermore, a subgroup of women with endometriosis suffered from dysuria compared to patients without endometriosis (32.2% vs. 4.3%, respectively). Remarkably, the numbers of significant parameters were significantly higher in women with endometriosis compared to women without endometriosis (14.10 ± 4.2 vs. 7.75 ± 5.8, respectively). A decision tree was developed, resulting in 0.904 sensitivity, 0.750 specificity, 0.874 positive predictive values (PPV), 0.802 negative predictive values (NPV), 28.235 odds ratio (OR), and 4.423 relative risks (RR). The PPV of 0.874 is comparable to the positive prediction of endometriosis by the clinicians of 0.86 (177/205). Conclusions: The presented predictive model will enable a non-invasive diagnosis of endometriosis and can also be used by both patients and clinicians for surveillance of the disease before and after surgery. In cases of positivety, as evaluated by the questionnaire, patients can then seek advice again. Similarly, patients without an operation but with medical therapy can be monitored with the questionnaire.
14
Ordiyants, I. M., D. S. Novginov, Z. V. Zyukina, A. M. Khachatryan, and S. E. Titov. "Non-invasive diagnostics of endometriosis based on plasma miRNA expression." Fundamental and Clinical Medicine 8, no. 4 (January 2, 2024): 24–36. http://dx.doi.org/10.23946/2500-0764-2023-8-4-24-36.
Анотація:
Aim. To develop a method for noninvasive diagnosis of external genital endometriosis based on plasma microRNA concentrations.Materials and Methods. 80 women of reproductive age who were admitted to the gynecological department for routine laparoscopy were retrospectively examined, according to the results of which and histological examination, the patients were divided into 2 groups: the main group — 54 patients with laparoscopically and histologically confirmed external genital endometriosis (EGE); the control group — 26 patients without EGE. Before laparoscopy, a blood sample was taken from all patients for a molecular-biological study of the expression of 10 microRNAs: miR-183, miR-125b, miR-126, miR-16, miR-15a, miR-200a, miR-20a, miR-21, miR-222 and miR-29b. Identification of the studied and normalizing RNAs (U6 RNA and 103a microRNA) was performed according to the method of Chen et al. The presented values of the expression of the studied microRNAs are given in the form of 2-ΔCt. The expression ratio is given in the form of 2-ΔCt (main)/2-ΔCt (control), if the expression in the group of patients with endometriosis exceeded that in the control group, and in the form of 2-ΔCt (control)/2-ΔCt (main), if vice versa.Results. Comparison of the expression of 10 mi-croRNAs between the two groups revealed statistically significant differences only in miR-183: its expression in patients with EGE was statistically 1.5 times higher than that in women of the control group (p=0.017).We have not detected a difference in the expression of mir-200a, while according to other researchers, representatives of the mir-200 family are among the most frequent whose expression changes with endometriosis. MIR-16 expression also did not differ statistically among the patients we examined, whereas a group of American colleagues revealed its increase in patients with endometriosis and with endometriosis-associated ovarian tumors. We found no difference in mir-21 expression. The results of other researchers are contradictory: some found its increase in endometrioid cysts compared with eutopic endometrium, an increase in the epithelium of the fallopian tubes with their endometriosis compared with unaffected; others did not reveal a difference between the eutopic endometrium of endometriosis patients and healthy women, but showed a decrease in expression in peritoneal foci and foci of deep infiltrative endometriosis compared with eutopic endometrium.The expression of mir-222 was reduced in the patients we examined with endometriosis, which goes against the existing ideas about the pro-oncogenic role of this microRNA. An increase in its expression in cancer of the stomach, bladder, liver, lungs, breast, endometrium, ovaries is described. At the same time, the oncosuppressive effect of mir-222 is also known in prostate cancer, squamous cell carcinoma of the oral cavity.Conclusion. Taking into account the revealed statistically significant difference in microRNA expression by ROC analysis, we determined their effectiveness and specificity in the diagnosis of EGE. Of course, further studies with a large contingent of patients are needed to confirm the diagnostic value of these biomarkers. In addition, our study did not allow us to establish a statistical difference in microRNA expression in patients with impaired fertility. But it is the test that makes it possible to differentiate female infertility — associated with endometriosis and without it, as a rule, tubal-peritoneal genesis — that will become a key tool in the personalized management of patients with infertility.In our work, the distribution of patients by stages of EGE turned out to be uneven (there were no women with stage I at all) and it was not possible to establish a statistical difference in microRNA expression depending on the "length of service" of the disease.
15
Poujois, Julie, Cécile Mézan De Malartic, Ronan Callec, Laurent Bresler, Nicolas Hubert, Philippe Judlin, and Oliver Morel. "Deep infiltrating endometriosis: Interest of the robotic approach for a fledgling team." Journal of Endometriosis and Pelvic Pain Disorders 11, no. 3 (May 27, 2019): 152–57. http://dx.doi.org/10.1177/2284026519850369.
Анотація:
Introduction: Mini-invasive surgery of deep endometriosis is challenging. Surgical difficulties related to the technical limitations of classical laparoscopic approach might be overcome with the use of robotic assistance. The aim of this study was to evaluate the safety and feasibility of robotic surgery for deep infiltrating endometriosis in the learning phase of our team. Methods: The 20 first cases of robotic-assisted laparoscopies for endometriosis were included over a 2-year period. Baseline characteristics of patients and surgical data were reviewed. Surgical outcomes and follow-up information of the patients were analyzed. Results: Twenty women were included. The mean age was 31.9 years (range: 25–44) and mean body mass index was 23 kg/m2 (range: 16–35). Ten patients had rectovaginal or uterosacral location only (50%) and nine women had deep infiltrating endometriosis with digestive or urinary tract lesions (45%). In addition to the gynecologic surgeon, urologic or visceral surgeons were required in 10 cases, and there were 3 cases where the three specialties were needed. The mean operative time was 183.9 min (range: 85–398) and no difference was observed between the first five cases and the last five cases. There was one laparoconversion, and only two urologic postoperative complications occurred. Conclusion: Thanks to the use of robotic surgical assistance and a multidisciplinary approach, and despite the start of the team for deep endometriosis care, no learning curve effect was observed regarding surgical procedures’ success, safety, or duration. The use of robotic assistance might improve the quality of care for women facing deep endometriosis.
16
Raffone, Antonio, Diego Raimondo, Alessia Oliviero, Arianna Raspollini, Antonio Travaglino, Marco Tortorella, Gaetano Riemma, et al. "The Use of near Infra-Red Radiation Imaging after Injection of Indocyanine Green (NIR–ICG) during Laparoscopic Treatment of Benign Gynecologic Conditions: Towards Minimalized Surgery. A Systematic Review of Literature." Medicina 58, no. 6 (June 13, 2022): 792. http://dx.doi.org/10.3390/medicina58060792.
Анотація:
Background and Objectives: To assess the use of near infrared radiation imaging after injection of indocyanine green (NIR–ICG) during laparoscopic treatment of benign gynecologic conditions. Materials and Methods: A systematic review of the literature was performed searching 7 electronic databases from their inception to March 2022 for all studies which assessed the use of NIR–ICG during laparoscopic treatment of benign gynecological conditions. Results: 16 studies (1 randomized within subject clinical trial and 15 observational studies) with 416 women were included. Thirteen studies assessed patients with endometriosis, and 3 studies assessed non-endometriosis patients. In endometriosis patients, NIR–ICG use appeared to be a safe tool for improving the visualization of endometriotic lesions and ureters, the surgical decision-making process with the assessment of ureteral perfusion after conservative surgery and the intraoperative assessment of bowel perfusion during recto-sigmoid endometriosis nodule surgery. In non-endometriosis patients, NIR–ICG use appeared to be a safe tool for evaluating vascular perfusion of the vaginal cuff during total laparoscopic hysterectomy (TLH) and robotic-assisted total laparoscopic hysterectomy (RATLH), and intraoperative assessment of ovarian perfusion in adnexal torsion. Conclusions: NIR–ICG appeared to be a useful tool for enhancing laparoscopic treatment of some benign gynecologic conditions and for moving from minimally invasive surgery to minimalized surgery. In particular, it might improve treatment of endometriosis (with particular regard to deep infiltrating endometriosis), benign diseases requiring TLH and RATLH and adnexal torsion. However, although preliminary findings appear promising, further investigation with well-designed larger studies is needed.
17
Horné, Fabian, Raimund Dietze, Eniko Berkes, Frank Oehmke, Hans-Rudolf Tinneberg, Ivo Meinhold-Heerlein, and Lutz Konrad. "Impaired Localization of Claudin-11 in Endometriotic Epithelial Cells Compared to Endometrial Cells." Reproductive Sciences 26, no. 9 (December 4, 2018): 1181–92. http://dx.doi.org/10.1177/1933719118811643.
Анотація:
Claudins are the major components of tight junctions and are often deregulated in human cancer, permitting escape of cancer cells along with the acquisition of invasive properties. Similarly, endometrial cells also show invasive capabilities; however, the role of tight junctions in endometriosis has only rarely been examined. In this study, we analyzed the protein expression and localization of claudin-7 and claudin-11 in human eutopic and ectopic endometrium and endometrial cell lines. We identified claudin-7 primarily at the basolateral junctions of the glandular epithelial cells in eutopic endometrium as well as in the ectopic lesions in nearly all glands and cysts. Quantification of claudin-7 localization by HSCORE showed a slight increase in peritoneal and deep infiltrating endometriosis (DIE) compared to eutopic endometrium. In contrast, claudin-11 was localized mainly in the apicolateral junctions in nearly all glandular epithelial cells of the eutopic endometrium. Interestingly, we observed a deregulation of claudin-11 localization to a basal or basolateral localization in ovarian ( P < .001), peritoneal ( P < .01), and DIE ( P < .05) and a moderately decreased abundance in ovarian endometriosis. In endometrial cell lines, claudin-7 was only present in epithelial Ishikawa cells, and silencing by small-interfering RNA increased cell invasiveness. In contrast, claudin-11 could be demonstrated in Ishikawa and endometriotic 12Z and 49Z cells. Silencing of claudin-11 decreased invasiveness of 12Z slightly but significantly in 49Z. We suggest that although claudin-7 and claudin-11 can be found in nearly all eutopic and ectopic epithelial cells, the impaired localization of claudin-11 in ectopic endometrium might contribute to the pathogenesis of endometriosis.
18
Vlek, S. L., M. C. I. Lier, T. W. A. Koedam, I. Melgers, J. J. M. L. Dekker, J. H. Bonjer, V. Mijatovic, and J. B. Tuynman. "Transanal minimally invasive rectal resection for deep endometriosis: a promising technique." Colorectal Disease 19, no. 6 (June 2017): 576–81. http://dx.doi.org/10.1111/codi.13569.
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Perricos, Alexandra, Heinrich Husslein, Lorenz Kuessel, Manuela Gstoettner, Andreas Weinhaeusel, Thomas Eiwegger, Gabriel Beikircher, and René Wenzl. "Does the Use of the “Proseek® Multiplex Inflammation I Panel” Demonstrate a Difference in Local and Systemic Immune Responses in Endometriosis Patients with or without Deep-Infiltrating Lesions?" International Journal of Molecular Sciences 24, no. 5 (March 6, 2023): 5022. http://dx.doi.org/10.3390/ijms24055022.
Анотація:
Endometriotic lesions are able to infiltrate surrounding tissue. This is made possible partly by an altered local and systemic immune response that helps achieve neoangiogenesis, cell proliferation and immune escape. Deep-infiltrating endometriosis (DIE) differs from other subtypes through the invasion of its lesions over 5 mm into affected tissue. Despite the invasive nature of these lesions and the wider range of symptoms they can trigger, DIE is described as a stable disease. This elicits the need for a better understanding of the underlying pathogenesis. We used the “Proseek® Multiplex Inflammation I Panel” in order to simultaneously detect 92 inflammatory proteins in plasma and peritoneal fluid (PF) of controls and patients with endometriosis, as well as in particular patients with DIE, in order to gain a better insight into the systemically and locally involved immune response. Extracellular newly identified receptor for advanced gycation end-products binding protein (EN-RAGE), C-C motif Chemokine ligand 23 (CCL23), Eukaryotic translation initiation factor 4—binding protein 1 (4E-BP1) and human glial cell-line derived neurotrophic factor (hGDNF) were significantly increased in plasma of endometriosis patients compared to controls, whereas Hepatocyte Growth factor (HGF) and TNF-related apoptosis inducing ligand (TRAIL) were decreased. In PF of endometriosis patients, we found Interleukin 18 (IL-18) to be decreased, yet Interleukin 8 (IL-8) and Interleukin 6 (IL-6) to be increased. TNF-related activation-induced cytokine (TRANCE) and C-C motif Chemokine ligand 11 (CCL11) were significantly decreased in plasma, whereas C-C motif Chemokine ligand 23 (CCL23), Stem Cell Factor (SCF) and C-X-C motif chemokine 5 (CXCL5) were significantly increased in PF of patients with DIE compared to endometriosis patients without DIE. Although DIE lesions are characterized by increased angiogenetic and pro-inflammatory properties, our current study seems to support the theory that the systemic immune system does not play a major role in the pathogenesis of these lesions.
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Pavone, M., M. Goglia, F. Campolo, G. Scambia, and M. M. Ianieri. "En-block butterfly excision of posterior compartment deep endometriosis: The first experience with the new surgical robot Hugo™ RAS." Facts, Views and Vision in ObGyn 15, no. 4 (December 2023): 359–62. http://dx.doi.org/10.52054/fvvo.14.5.104.
Анотація:
Background: Minimally invasive surgery is the gold standard treatment for deep endometriosis when medical management fails. In selected cases, such as when bowel or urinary tract are involved, robotic assisted surgery can be useful due to its characteristics of high dexterity and manoeuvrability. This is the first case of robotic en-bloc excision of posterior compartment deep endometriosis performed with the new HugoTM RAS system. Objective: The purpose of this video article is to show for the first time the feasibility of bowel surgery for deep endometriosis with this new robotic device. Materials and methods: A 24-years-old woman affected by severe dysmenorrhea, chronic pelvic pain, dyschezia and dyspareunia underwent to deep endometriosis excision using the new robotic platform HugoTM RAS system at the Unit of Gynaecological Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. Main outcome measures: Intraoperative data, docking set up, post-operative outcomes up to three months follow up were evaluated. Results: The surgical procedure was carried out without intra-operative or post-operative complications, operative time (OT) was 200 minutes, while docking time was 8 minutes. No system errors or faults in the robotic arms were registered. Post-operative complete disease-related symptoms relief was reported. Conclusion: According to our results, the introduction of this new robotic platform in the surgical management of deep endometriosis seems to be feasible, especially in advanced cases. However, further studies are needed to demonstrate the benefits of this surgical system and the advantages of robotic surgery compared to laparoscopy in this subset of patients.
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Maruyama, Tetsuo. "A Revised Stem Cell Theory for the Pathogenesis of Endometriosis." Journal of Personalized Medicine 12, no. 2 (February 4, 2022): 216. http://dx.doi.org/10.3390/jpm12020216.
Анотація:
During the past decade, a stem cell-based hypothesis has emerged (among many others) to explain the pathogenesis of endometriosis. The initial hypothesis proposed that endometriosis arose from a single or a few specific cells with stem cell properties, including self-renewal and multi-lineage cell differentiation. The origins of the endometriosis-initiating stem cells were thought to be the bone marrow, uterine endometrium, and other tissues. Based on the implantation or metastatic theory in combination with the initial stem cell theory, one or a few multipotent stem/progenitor cells present in the eutopic endometrium or bone marrow translocate to ectopic sites via fallopian tubes during menstruation, vasculolymphatic routes, or through direct migration and invasion. Subsequently, they give rise to endometriotic lesions followed by differentiation into various cell components of endometriosis, including glandular and stromal cells. Recent somatic mutation analyses of deep infiltrating endometriosis, endometrioma, and eutopic normal endometrium using next-generation sequencing techniques have redefined the stem cell theory. It is now proposed that stem/progenitor cells of at least two different origins—epithelium and stroma—sequentially, differentially, but coordinately contribute to the genesis of endometriosis. The dual stem cell theory on how two (or more) stem/progenitor cells differentially and coordinately participate in the establishment of endometriotic lesions remains to be elucidated. Furthermore, the stem/progenitor cells involved in this theory also remain to be identified. Given that the origin of endometriosis is eutopic endometrium, the candidate cells for endometriotic epithelium-initiating cells are likely to be endometrial epithelial cells positive for either N-cadherin or SSEA-1 or both. The candidate cells for endometriotic stroma-initiating cells may be endometrial mesenchymal stem cells positive for SUSD2. Endometrial side population cells are also a possible candidate because they contain unipotent or multipotent cells capable of behaving as endometrial epithelial and stromal stem/progenitor cells.
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Knox, Steven. "When to MRI." Fertility & Reproduction 05, no. 04 (December 2023): 210. http://dx.doi.org/10.1142/s2661318223740249.
Анотація:
MRI is a non-invasive second line tool which can make a valuable contribution to the diagnosis and pre surgical mapping of pelvic endometriosis. It is validated and serves as an adjunct to high quality ultrasound. It has particular strengths in the mapping of complex obliterative deep cul de sac disease and adjacent organ involvement. It has high sensitivity and specificity in diagnosing pelvic endometriosis and can upstage the degree of endometriosis compared to diagnostic laparoscopy. The use of MRI for endometriosis in Australia has significantly increased in the last 5 years and there is growing national and international research occurring in this space. Access has also improved dramatically for patients since the allocation of $25m of funding to make available Medicare funding for MRI imaging of suspected significant endometriosis by the Federal Government in mid-2022. As clinician and community awareness of improved MRI access grows, it is even more important to have a working knowledge of the strengths and weaknesses of MRI for anyone involved in the diagnosis, workup, and management of patients with suspected or proven endometriosis.
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Lüchinger, Annemarie B., Milou P. H. Busard, Velja Mijatovic, Jan Hein T. M. van Waesberghe, Chris J. Mulder, and Peter G. A. Hompes. "Cyclic Hematochezia: A Sign of Intestinal Endometriosis? An Evaluation by Magnetic Resonance Imaging and Colonoscopy." Journal of Endometriosis 3, no. 1 (January 2011): 47–52. http://dx.doi.org/10.5301/je.2011.8325.
Анотація:
Purpose Intestinal bowel endometriosis is reported in up to 37% of women with proven endometriosis. The aim of this study was to evaluate by colonoscopy and magnetic resonance imaging, patients suspected of deep infiltrating endometriosis (DIE) including the bowel wall that presented with cyclic hematochezia. Methods Twenty-four patients with cyclic hematochezia were retrospectively analyzed on colonoscopic features of colonoscopy, corresponding biopsy data, and outcome of magnetic resonance imaging evaluation. Fifteen out of 24 patients underwent bowel resection because of insufficient response to hormonal treatment (N=14) or obstructive ileus (N=1). Outcome of surgery and histologic examination of the resected specimens were evaluated. Results Colonoscopy proved intestinal endometriosis in only one out of 24 (4%) patients with cyclic hematochezia. In 13 out of 15 bowel resections endometriosis was found at histopathology. The location and dimension of lesions during surgery correlated well with magnetic resonance imaging findings. However, magnetic resonance imaging revealed a limited capacity to detect luminal narrowing of the bowel. Conclusions This study shows that colonoscopic findings of bowel endometriosis are aspecific. Colonoscopy, an invasive investigation, should therefore not be performed to diagnose endometriosis infiltrating the bowel wall. Magnetic resonance imaging provides good diagnostic work-up and in selected patients a roadmap to surgery.
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Kale, A., Y. Aboalhasan, E. C. Gündoğdu, T. Usta, and E. Oral. "Obturator nerve endometriosis: A systematic review of the literature." Facts, Views and Vision in ObGyn 14, no. 3 (September 2022): 219–23. http://dx.doi.org/10.52054/fvvo.14.3.032.
Анотація:
Background: Symptomatic obturator nerve endometriosis is a rare condition. In this paper, we aim to review and discuss the characteristics of obturator nerve endometriosis in light of current literature. Methods: An electronic search was conducted using the PubMed/Medline database. Results: Symptomatic obturator nerve endometriosis is rare; only 8 cases have been reported in the literature. Symptoms including difficulty walking, weak thigh adduction and pain in the inner thigh, which are all related to obturator nerve function, could be seen in the case of the entrapment of the nerve by endometrial nodules. A history of recurrent symptoms during menstrual cycles and physical examination, combined with appropriate radiologic imaging, led to a suspicion of obturator nerve involvement. Conclusion: Early diagnosis and surgical treatment of obturator nerve endometriosis is essential to minimise the nerve damage caused by recurrent cycles of bleeding and fibrosis, which are characteristics of endometriosis. The laparoscopic minimally invasive technique is feasible for the surgery of obturator nerve endometriosis. It offers the advantage of precise discrimination of vital structures and excellent access to deep anatomic sites. What is new? Obturator nerve endometriosis may be a severe cause of chronic pelvic pain in women of reproductive age. Treatment may be achieved surgically and in experienced hands, laparoscopic surgery would be the preferred choice.
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Sileri, Pierpaolo, Vito M. Stolfi, Chiara Di Pietro, Massimiliano Marziali, Francesco Sesti, Domenico Benavoli, Emilio Piccione, and Achille Gaspari. "W1505 Minimally Invasive Treatment of Deep Pelvic Endometriosis Involving the Intestine: Our Experience." Gastroenterology 136, no. 5 (May 2009): A—927. http://dx.doi.org/10.1016/s0016-5085(09)64288-8.
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Rault, Emmanuel, Charles-André Philip, Marion Cortet, and Gil Dubernard. "Virtual cystoscopy and colonoscopy to assess deep infiltrating endometriosis." Journal of Endometriosis and Pelvic Pain Disorders 11, no. 1 (January 8, 2019): 3–6. http://dx.doi.org/10.1177/2284026518818976.
Анотація:
Introduction: Faced with a suspicion of endometriosis, transvaginal sonography is the first-line procedure to diagnose deep infiltrating endometriosis. Methods: We recently introduced the FlyThru® mode from TOSHIBA aplio 500. With the 3D acquisition (Multiplanar Reconstruction), we can assess the deep invasion of the endometriosis nodule into the digestive and bladder wall and provide a virtual colonoscopy or cystoscopy. The entire wall of the organ can be explored either by starting the animation or by rotating the arrow. The detection threshold can be adjusted manually from 45 to 100 in order to remove any artifacts. Results: We reported two deep infiltrating endometriosis nodules explored with FlyThru mode: the first one in the rectum and the second in the bladder. Similar to a colonoscopy, the virtual animation of the FlyThru mode showed the progression into the intestine lumen until the visualization of the bulge of the nodule. Operators can appreciate precisely the location, the degree of stenosis, and the circumferential involvement of the bowel wall. The bulges of the two nodules were also visible into the bladder. The size of the lesions was assessed and related to bladder volume, which represents important preoperative data. Conclusion: Three dimensional-transvaginal sonography combined with the FlyThru mode allows the enhanced practitioner to diagnose and assess the invasion of an endometriosis nodule in a single procedure.
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Menzhinskaya, Irina V., Stanislav V. Pavlovich, Arika G. Melkumyan, Vladimir D. Chuprynin, Ekaterina L. Yarotskaya та Gennady T. Sukhikh. "Potential Significance of Serum Autoantibodies to Endometrial Antigens, α-Enolase and Hormones in Non-Invasive Diagnosis and Pathogenesis of Endometriosis". International Journal of Molecular Sciences 24, № 21 (25 жовтня 2023): 15578. http://dx.doi.org/10.3390/ijms242115578.
Анотація:
The objective of the study was to evaluate the profile of serum autoantibodies and their diagnostic and pathogenetic significance in ovarian endometrioma (OEM) and deep infiltrative endometriosis (DIE). The study enrolled 74 patients with endometriosis (Group 1), including 53 patients with OEM (Subgroup 1a); 21 patients with DIE without ovarian lesions (Subgroup 1b); and 27 patients without endometriosis (Group 2). The diagnosis was confirmed by laparoscopic surgery and histologic examination of resected tissues. Antibodies (M, G) to tropomyosin 3 (TPM), tropomodulin 3 (TMOD), α-enolase (ENO), estradiol (E2), progesterone (PG), and human chorionic gonadotropin (hCG) were identified in blood serum using modified ELISA. In endometriosis, antibodies to endometrial antigens, hormones, and ENO were detected more often than antiphospholipid and antinuclear antibodies. Higher levels of IgM to TPM, hCG, E2, and PG and IgG to TMOD, ENO, E2, and hCG were found in Subgroup 1a compared to Group 2. IgM to TPM, hCG, E2, PG, and IgG to E2 and ENO had a high diagnostic value for OEM (AUC > 0.7), with antibodies to TPM having the highest sensitivity and specificity (73.6% and 81.5%). In Subgroup 1b, only the levels of IgM to TPM and hCG were higher than in Group 2. These antibodies had a high diagnostic value for DIE. Thus, endometriosis is associated with autoantibodies to endometrial antigens, α-enolase, steroid, and gonadotropic hormones. A wider spectrum of antibodies is detected in OEM than in DIE. These antibodies have a high diagnostic value for OEM and DIE and potential pathogenetic significance for endometriosis and associated infertility.
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Naem, Antoine, Argyrios Andrikos, Alin Stefan Constantin, Michael Khamou, Dimitrios Andrikos, Antonio Simone Laganà, Rudy Leon De Wilde, and Harald Krentel. "Diaphragmatic Endometriosis—A Single-Center Retrospective Analysis of the Patients’ Demographics, Symptomatology, and Long-Term Treatment Outcomes." Journal of Clinical Medicine 12, no. 20 (October 11, 2023): 6455. http://dx.doi.org/10.3390/jcm12206455.
Анотація:
Diaphragmatic endometriosis is rare and forms 0.67–4.7% of all endometriosis cases. Evidence regarding its optimal management is lacking. In this study, we retrospectively analyzed the patient characteristics and long-term treatment outcomes of diaphragmatic endometriosis patients. Over a 4-year period, 23 patients were diagnosed with diaphragmatic endometriosis. The majority of patients had coexisting deep pelvic endometriosis. Cyclic upper abdominal pain was reported by 60.9% of patients, while cyclic chest and shoulder pain were reported by 43.5% and 34.8% of patients, respectively. Most patients were treated with laparoscopic lesion ablation, while 21.1% were treated with minimally invasive excision. The mean follow-up time was 23.7 months. Long-lasting resolution of the chest, abdominal, and shoulder pain occurred in 50%, 35.7%, and 25% of patients, respectively. Nonetheless, 78.9% of patients reported major improvement in their symptoms postoperatively. Significantly higher rates of postoperative shoulder, abdominal, and chest pain were observed in patients who received postoperative hormonal therapy compared with those who did not. All patients treated expectantly remained stable. Therefore, we recommend treating diaphragmatic endometriosis only in symptomatic patients. The risk of incomplete surgery should be minimized by a multidisciplinary diagnostic and therapeutic approach with a careful assessment of the diaphragm and the thoracic cavity.
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Goncalves, Manoel Orlando, Joao Siufi Neto, Marina Paula Andres, Daniela Siufi, Leandro Accardo de Mattos, and Mauricio S. Abrao. "Systematic evaluation of endometriosis by transvaginal ultrasound can accurately replace diagnostic laparoscopy, mainly for deep and ovarian endometriosis." Human Reproduction 36, no. 6 (April 16, 2021): 1492–500. http://dx.doi.org/10.1093/humrep/deab085.
Анотація:
Abstract STUDY QUESTION What is the sensitivity and the specificity of preoperative transvaginal ultrasound with bowel preparation (TVUS-BP) compared to diagnostic laparoscopy (DL) for the identification of ovarian and deep sites of endometriosis? SUMMARY ANSWER DL was able to detect retrocervical, ovarian, and bladder endometriosis with similar sensitivity and specificity as TVUS-BP, whereas for vaginal and rectosigmoid endometriosis, DL had lower sensitivity and specificity than TVUS-BP. WHAT IS KNOWN ALREADY TVUS-BP is a non-invasive examination with good accuracy for diagnosing ovarian and deep endometriosis. DL is expensive and can lead to surgical complications. STUDY DESIGN, SIZE, DURATION This prospective study included a total of 120 consecutive patients who underwent surgery for suspected endometriosis with preoperative imaging (TVUS-BP), including a video of the laparoscopic procedure, between March 2017 and September 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS Two radiologists performed preoperative TVUS-BP using the same protocol for diagnosing endometriosis. Two surgeons, who were blinded to the results of the preoperative imaging and clinical data, reviewed the surgical videos from the entry of the abdominal cavity until the surgeon finalized a complete and systematic review prior to beginning any dissection (considered as a DL). A data sheet was used by surgeons and radiologists to record the sites and size of disease involvement, the American Society for Reproductive Medicine (ASRM) stage, and the Enzian score. The surgical visualization of endometriosis lesions that were confirmed by histological analysis was the gold standard. MAIN RESULTS AND THE ROLE OF CHANCE DL was able to detect retrocervical, ovarian, and bladder endometriosis with similar sensitivity and specificity as TVUS-BP. DL was not able to detect vaginal endometriosis (sensitivity and specificity 0%): this is compared to a sensitivity and specificity of 85.7% and 99.1%, respectively with the utilization of a preoperative TVUS-BP. In addition, DL was notably poor at detecting rectosigmoid endometriosis, with a sensitivity of 3.7–5.6%, and this compares to 96.3% sensitivity with utilization of a preoperative TVUS (P < 0.001). For the ASRM stage, TVUS-BP results were highly correlated with the degree of endometriosis and pouch of Douglas (POD) obliteration (weighted Kappa of 0.867 and 0.985, respectively). For the Enzian score, there was a substantial correlation between TVUSP-BP and DL for compartment A (weighted Kappa = 0.827), compartment B (weighted Kappa = 0.670), and compartment C (weighted kappa = 0.814). LIMITATIONS, REASONS FOR CAUTION The number of participants included may be a limitation in this study and, as the evaluators were blinded to the physical exam, the DL accuracy could be underestimated. As biopsies of pelvic organs were obtained only if there was a suspicion of endometriosis, the gold standard was not always applicable. This aspect could underestimate the prevalence of lesions and overestimate the sensitivity and the specificity of both the TVUS-BP and the DL. WIDER IMPLICATIONS OF THE FINDINGS Preoperative TVUS-BP was accurate in identifying all sites of ovarian and deep endometriosis that were evaluated. It had significantly higher sensitivity than DL in detecting rectosigmoid endometriosis and predicting intraoperative ASRM staging and the Enzian score. These results suggest that TVUS-BP can replace DL for the diagnosis and treatment planning for patients with ovarian and deep endometriosis. STUDY FUNDING/COMPETING INTEREST(S) The authors declare no source of funding or conflicts of interest. TRIAL REGISTRATION NUMBER N/A
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Marchenko, K. D., A. G. Gramatikova, O. V. Lukina, V. F. Bezhenar, and E. V. Bubnova. "Correlation between MR semiotics and intensity of pelvic pain syndrome in female patients with deep infiltrating endometriosis of the posterior pelvic compartment." Regional blood circulation and microcirculation 23, no. 1 (April 7, 2024): 44–49. http://dx.doi.org/10.24884/1682-6655-2024-23-1-44-49.
Анотація:
Objective. To identify the correlation between magnetic resonance (MR) semiotics and the intensity of pelvic pain syndrome in female patients with deep infiltrating endometriosis of the posterior pelvic compartment. Material and methods. We performed a retro- and prospective analysis of MR studies of pelvic organs in 77 female patients with pelvic pain syndrome, aged from 24 to 39 years. We assessed the intensity of the pain syndrome using a visual analog scale (VAS). The patients were divided into 2 groups: 1st-patients with external genital endometriosis (EGE) without involving the posterior pelvic compartment, 2nd-patients with EGE of the posterior pelvic compartment. The patients of the second group were divided into subgroups: 1 – endometriosis of the posterior pelvic compartment without MR signs of intestinal wall invasion, 2 – posterior compartment endometriosis with MR signs of intestinal wall invasion. The study was conducted on a GE Signa 1.5 Tesla MRI scanner. Results. In the second group of patients with endometriosis of the posterior pelvic compartment, the pain syndrome (8.00 (7.00–9.00) was more intense than in the first group of patients without endometriosis of the posterior pelvic compartment 7.00 (5.00–7.00), p<0.001 and we evaluated a retrovaginal, retrocervical and posterior uterine localization. In the second subgroup of patients with signs of the intestinal wall invasion, the pelvic pain syndrome on the VAS was statistically significantly more intense 8.00 (8.00-10.00) than in the first subgroup of patients without signs of the intestinal wall invasion 7.00 (6.00–7.00) (P<0.001). Conclusion. Patients with identified deep infiltrating endometriosis of the posterior pelvic compartment have more pronounced manifestations of the pelvic pain syndrome then patients with endometriosis of other localizations.
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Hiltunen, Janika, Marja-Liisa Eloranta, Auni Lindgren, Leea Keski-Nisula, Maarit Anttila, and Hanna Sallinen. "Robotic-assisted laparoscopy is a feasible method for resection of deep infiltrating endometriosis, especially in the rectosigmoid area." Journal of International Medical Research 49, no. 8 (August 2021): 030006052110327. http://dx.doi.org/10.1177/03000605211032788.
Анотація:
Objective This study aimed to compare outcomes of mini-invasive surgical treatment of endometriosis, especially conventional laparoscopy with robotic-assisted laparoscopy, and to evaluate the quality of life. Methods One hundred three consecutive patients with endometriosis who had surgery from 2014 to 2017 owing to an indication of pain were enrolled in this retrospective study. The majority (n = 77, 75%) of patients underwent conventional laparoscopy and 18 (17%) had robotic-assisted laparoscopy. The quality of life was postoperatively assessed with a questionnaire. Results The rates of parametrectomy (76% vs. 45%,) and rectovaginal resection (28% vs. 4%) were significantly higher in robotic-assisted laparoscopy than in laparoscopy. Additionally, the rate of bowel operations (50% vs. 17%), especially the shaving technique, was higher in robotic-assisted laparoscopy surgery than in laparoscopy (39% vs. 8%). There was no difference in the rate of postoperative complications between laparoscopy and robotic-assisted laparoscopy. Most (91%) of the patients who answered the questionnaire felt that surgical treatment had relieved their pain. In the laparoscopic and robotic-assisted groups, 88% of respondents felt that their quality of life had improved after surgery. Conclusions This study suggests that robotic-assisted laparoscopy is a feasible method to resect deep infiltrating endometriosis, especially in the rectosigmoid area.
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Legendri, Sophie, Marie Carbonnel, Anis Feki, Gaby Moawad, Gabrielle Aubry, Alexandre Vallée, and Jean-Marc Ayoubi. "Improvement of Post-Operative Quality of Life in Patients 2 Years after Minimally Invasive Surgery for Pain and Deep Infiltrating Endometriosis." Journal of Clinical Medicine 11, no. 20 (October 18, 2022): 6132. http://dx.doi.org/10.3390/jcm11206132.
Анотація:
This study addressed the improvement in the quality of life of patients 2 years after minimally invasive surgery for painful deep infiltrating endometriosis (DIE), evaluated with EHP-5 (Endometriosis Health Profile-5) scores and the intensity of dysmenorrhea and dyspareunia. This was a retrospective study, performed in a referral centre for endometriosis, between January 2010 and January 2019. EHP-5 scores were complete for 54 patients, and two subgroups were analysed: classic laparoscopy (CL) vs. robotic laparoscopy (RL), and conservative surgery (ConservS) vs. total surgery (TS). There was an important decrease in 2-year post-operative EHP-5 scores in the global population (pre-op: 61.36 (42.18–68.75) and 2-year post-op: 20.45 (0–38.06); p < 0.001). The Visual Analogic Scale (VAS) was also lower for dysmenorrhea (pre-op: 8 (7–9.75) vs. 2-year post-op: 3 (2–5.25); p < 0.001) and dyspareunia (pre-op: 6 (3.1–8.9) vs. 2-year post-op: 3 (0–6); p < 0.001). In the subgroup analysis, EHP-5 scores were improved in the RL group (pre-op: 65.9 (59.09–71.02) vs. 2-year post-op: 11.4 (0–38.06); p < 0.001) and the CL group (pre-op: 50 (34.65–68.18) vs. 2-year post-op: 27.27 (14.20–40.90); p < 0.001), with a slight advantage for RL (p = 0.04), and the same improvements were found for ConservS (pre-op: 61.4 (38.06–71.59) vs. 2-year post-op: 22.7 (11.93–38.07); p < 0.001) and TS groups (pre-op: 61.59 (51.70–68.75) vs. 2-year post-op: 13.63 (0–44.30); p < 0.001). Minimally invasive surgery improved the quality of life for DIE patients 2 years after surgery, and conservative surgery showed comparable results to total surgery.
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Snyder, Benjamin M., Joseph W. Beets, Bruce A. Lessey, Samuel R. W. Horton, and Gary A. Abrams. "Postmenopausal Deep Infiltrating Endometriosis of the Colon: Rare Location and Novel Medical Therapy." Case Reports in Gastrointestinal Medicine 2018 (2018): 1–5. http://dx.doi.org/10.1155/2018/9587536.
Анотація:
We report an uncommon case of deep infiltrating endometriosis of the colon presenting as iron deficiency anemia nine years after hysterectomy with bilateral salpingo-oophorectomy. The endometrial implant was found at the hepatic flexure, an exceedingly rare location for endometriosis invasion with no cases distinctly reported in the literature. Additionally, the presentation of gastrointestinal endometriosis as iron deficiency anemia is not well documented in the literature. Instead of surgery, we prescribed a novel medical therapeutic approach using conjugated estrogen-bazedoxifene to antagonize the proliferative effects of estrogen on endometrial tissue. After five months of therapy and repeat colonoscopy, no evidence of endometrial tissue remained in the hepatic flexure.
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Senat, Hanna, Patrycja Grabowska, Aleksandra Senat, Patrycja Bolla, Aleksandra Madej, Zuzanna Marczyńska, and Karolina Libracka. "Endometriosis: Pathogenesis, diagnosis, treatment and the role of gut microbiota." Journal of Education, Health and Sport 59 (February 13, 2024): 87–101. http://dx.doi.org/10.12775/jehs.2024.59.006.
Анотація:
Endometriosis is a common disease. It affects 5-10% of women of reproductive age worldwide. However, despite the prevalence, diagnosis is typically delayed by years, misdiagnosis is common, and effective treatment takes years to achieve. Determining the mechanisms involved in its pathogenesis is vital, not only to pave the way for early identification, but also for disease management and development of less invasive but successful treatment strategies. Three main typed of endometriosis have been described in literature: peritoneal, ovarian and deep infiltrative. This is mainly due to the most common locations of ectopis endometrium. .Determining the precise pathogenesis of endometriosis has proved challenging and controversial for gynecologists, endocrinologists and researchers, but recent studies have focused on finding answers. This disease is often asymptomatic and diagnosed incidentally during various surgical interventions or follow-up gynecological examinations. Epidemiological research reports that women with this disease are more vulnerable to ovarian and breast cancer, asthma, skin cancer suhc as melanoma, cardiovascular disease and rheumatoid arthritis. The connection of the gut microbiota and endometriosis is nowadays higly suspected to exist. Scientists are focused on the influence of the microbiome on estrogens, estrogens-dependent disorders, immune system and inflammation. It is strongly velieved that correction of the gut microbiota with antibiotica, probiotics, or fecal bacterial transplantation sie a hopeful method for improving the clinical management of endometriosis.
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ANTONOVICI, Marina Rodica, Oana Maria IONESCU, Horace ROMAN, and Claudia MEHEDINTU. "Imaging Diagnosis in Colorectal Endometriosis." Medicina Moderna - Modern Medicine 28, no. 2 (June 30, 2021): 215–22. http://dx.doi.org/10.31689/rmm.2021.28.2.215.
Анотація:
Colorectal deep infiltrative endometriosis (DIE) can have a major impact on patient’s health and quality of life. Surgical treatment of colorectal DIE varies depending on the location and characteristics of the lesions, which is why the preoperative non-invasive diagnosis needs to be correct and complete. Multiple imaging methods are currently available, but their usefulness is still being studied, as none of them has proven itself perfect. In the present study we wanted to find out to what extent the combined use of magnetic resonance imaging (MRI), endorectal ultrasound (ERUS) and computed tomography-based virtual colonoscopy (CTC) helps perform the preoperative mapping of lesions. We conducted a retrospective study of prospectively collected data that included 49 patients operated for colorectal DIE. In identifying rectal nodules, MRI as a single diagnostic method was the most useful. When ERUS or CTC was added, the concordance between intraoperative and imaging results was very strong. CTC was the most useful in identifying sigmoid nodules. ERUS evaluates the depth of rectal nodules best. CTC assesses best the stenosis for both rectal and sigmoid nodules. Each method contributed to the completion of the diagnosis, so performing ERUS and CTC in addition to MRI seems to be preferable in patients with colorectal DIE.
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Bassi, Marco Antonio, Victor Arias, Nicolau D’Amico Filho, Bárbara Yasmin Gueuvoghlanian-Silva, Mauricio Simoes Abrao, and Sergio Podgaec. "Deep Invasive Endometriosis Lesions of the Rectosigmoid May Be Related to Alterations in Cell Kinetics." Reproductive Sciences 22, no. 9 (February 26, 2015): 1122–28. http://dx.doi.org/10.1177/1933719115574341.
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Politova, Alla K., Andrey V. Maksimenkov, Yulia A. Vershinina, Anastasia D. Alexandrova, and Svetlana V. Dudorova. "Surgical treatment for colorectal endometriosis. A clinical case." Journal of obstetrics and women's diseases 71, no. 6 (February 7, 2023): 113–24. http://dx.doi.org/10.17816/jowd108025.
Анотація:
The article describes a clinical case of successful surgical treatment of a patient with deep endometriosis involving the rectum using the Da Vinci Surgical System. The use of the Da Vinci robotic complex allows for increasing the radicalism of the operation by improving visualization and expanding the surgeons manual capabilities. This starts to be possible thanks to the technical advantages of this technology, specifically 3D imaging and the use of EndoWrist instruments with artificial wrists and seven degrees of freedom that provide greater precision when manipulating in a minimally invasive environment. Surgical treatment of colorectal endometriosis includes three types of operations focus shaving, discoid and circular bowel resections with anastomosis. When choosing a treatment strategy, one needs to take into account the clinical course of the disease, the results of conservative treatment and instrumental methods of research (ultrasound, MRI), and the womans reproductive plans. The excision of the infiltrate is an effective method of treating patients with colorectal endometriosis in terms of pain relief, improving the quality of life and restoring reproductive function. Performing such operations is optimal in medical institutions with a multidisciplinary approach.
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Habiba, Marwan, Donatella Lippi, and Giuseppe Benagiano. "The History of the Discovery of Ectopic Epithelial Cells in Lower Peritoneal Organs: The So-Called Mucosal Invasion." Reproductive Medicine 2, no. 2 (April 7, 2021): 68–84. http://dx.doi.org/10.3390/reprodmed2020008.
Анотація:
Through microscopy, early researchers identified the epithelium on the inner surfaces of the uterus, cervix and Fallopian tubes. The identification of ectopic epithelium was gradual, starting from the gross pathology study of unusual cystic lesions. Towards the end of the nineteenth century, attention focused on the epithelium as a critical component. The term ‘adenomyoma’ was coined around eighteen eighty to designate the majority of mucosa-containing lesions. Several theories were advanced to explain its aetiology. In the main, lesions were considered to arise from invasion from uterine epithelium; implantation of endometrium through retrograde menstruation; hematogenous or lymphatic spread; or from embryonic remnants. Although initially widely rejected, around 1920, an almost unanimous consensus formed on the endometrial nature of epithelial invasions. During the following years, adenomyosis and endometriosis came to be used to distinguished lesions within or outside the uterus. Adenomyosis was attributed to direct infiltration of uterine mucosa into the myometrium, and endometriosis to the implantation of endometrial cells and stroma into the peritoneal cavity through retrograde menstruation. Around the same time, ovarian lesions, initially described as ovarian hematomas or chocolate cysts, were regarded as a form of endometriosis. Three variants of endometriosis were thus described: superficial peritoneal, deep nodular and ovarian endometriomas. Ectopic epithelium has long been recognised as having similarities to tubal, or cervical epithelium. Lesions containing mixed epithelium are often termed Müllerianosis. This article demonstrates the stepwise evolution of knowledge, the role of the pioneers and the difficulties that needed to be overcome. It also demonstrates the value of collaboration and the inter-connected nature of the scientific endeavour.
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Tsitskarava, Dmitry Z., Mariya I. Yarmolinskaya, Alexandr V. Selutin, and Sergey A. Selkov. "Evaluation of the content and the pathogenetic role of cytokines in the peritoneal fluid in patients with deep infiltrative endometriosis." Journal of obstetrics and women's diseases 66, no. 1 (January 15, 2017): 38–45. http://dx.doi.org/10.17816/jowd66138-45.
Анотація:
Background. Deep infiltrative endometriosis (DIE) is characterized by the invasion of endometriosis lesions in tissues and organs to a depth of over 5 mm. In recent years, the proportion of infiltrative forms of endometriosis has been steadily increasing. The main clinical manifestations is chronic pelvic pain syndrome and infertility. A key element in the pathogenesis of deep infiltrative endometriosis is an ineffective inflammatory response.Objective. Evaluate the content and the role of pro- and anti-inflammatory cytokines, growth factors and chemokines in the pathogenesis of deep infiltrative endometriosis for pathogenetically grounded immunomodulatory therapy.Materials and methods. The present study included 120 women with deep infiltrative endometriosis. In the peritoneal fluid, using IFA determined the level of IL-33, and with the help of running cytofluometry format NEA has estimated the levels of IL-2, IL-6, IL-10, IP-10, MCP-1 and growth factors – FGF, TGF-β.Results. In the study of peritoneal fluid of patients with DIE was a significant decrease in the level of IL-2 and IL-10 6.7 times compared to the control group. The level of IL-6 was increased in 1.5 times, as well as the level of IL-33, and was awarded the data link cytokines with the severity of pain. DIE is characterized by increased levels of MCP-1 in 2 times and decrease in IP-10 1.3 times, as well as increased levels of FGF 1.5 times and reduced levels of TGF-β in 1.9 times in comparison with the control group.Conclusion. For effective treatment of DIE and to increase the duration of recurrence-free period actual and pathogenetically justified is the inclusion of a combined treatment of immunomodulatory therapy with recombinant IL-2 aimed at the elimination of immunological disorders in the pelvic cavity.
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Rocha, R. M., J. V. C. Zanardi, C. Uzuner, J. Mak, and G. Condous. "Anatomical Distribution of Deep Endometriosis on Transvaginal Ultrasound and Clinical Features: Implications on Non-Invasive Diagnosis." Journal of Minimally Invasive Gynecology 28, no. 11 (November 2021): S87—S88. http://dx.doi.org/10.1016/j.jmig.2021.09.682.
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Xiang, Yuanhua, Gang Wang, Lingjuan Zhou, Qin Wang, and Qinjie Yang. "A systematic review and meta-analysis on transvaginal ultrasonography in the diagnosis of deep invasive endometriosis." Annals of Palliative Medicine 11, no. 1 (January 2022): 281–90. http://dx.doi.org/10.21037/apm-21-3761.
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Averbach, Marcelo, Pedro Popoutchi, Oswaldo Wiliam Marques Jr, Ricardo Z. Abdalla, Sérgio Podgaec, and Maurício Simões Abrão. "Robotic rectosigmoidectomy: pioneer case report in Brazil. Current scene in colorectal robotic surgery." Arquivos de Gastroenterologia 47, no. 1 (March 2010): 116–18. http://dx.doi.org/10.1590/s0004-28032010000100018.
Анотація:
Laparoscopic colorectal surgery is believed to be technically and oncologically feasible. Robotic surgery is an attractive mode in performing minimally-invasive surgery once it has several advantages if compared to standard laparoscopic surgery. The aim of this paper is to report the first known case of colorectal resection surgery using the robotic assisted surgical device in Brazil. A 35-year-old woman with deep infiltrating endometriosis with rectal involvement was referred for colorectal resection using da Vinci® surgical system. The authors also reviewed the most current series and discussed not only the safety and feasibility but also the real benefits of robotic colorectal surgery
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Abramiuk, Monika, Karolina Frankowska, Krzysztof Kułak, Rafał Tarkowski, Paulina Mertowska, Sebastian Mertowski, and Ewelina Grywalska. "Possible Correlation between Urocortin 1 (Ucn1) and Immune Parameters in Patients with Endometriosis." International Journal of Molecular Sciences 24, no. 9 (April 24, 2023): 7787. http://dx.doi.org/10.3390/ijms24097787.
Анотація:
The etiology of endometriosis (EMS) has not been clearly elucidated yet, and that is probably the reason why its diagnostic process is frequently long-lasting and inefficient. Nowadays, the non-invasive diagnostic methods of EMS are still being sought. Our study aimed to assess the serum and peritoneal fluid levels of urocortin 1 (Ucn1) in patients with EMS and healthy women. Moreover, considering the immune background of the disease, the association between Ucn1 and several immune parameters was studied in both groups. We found that the serum Ucn1 level was significantly upregulated in women with EMS compared to healthy patients. Moreover, higher serum Ucn1 levels tended to correspond with more advanced stages of the disease (p = 0.031). Receiver operating characteristic (ROC) analysis revealed that based on serum Ucn1 levels, it is possible to distinguish deep infiltrating endometriosis (DIE) from among other EMS types. Together, these results indicate Ucn1 as a possible promising biomarker of EMS: however, not in isolation, but rather to enhance the effectiveness of other diagnostic methods.
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Rocha, R. M., M. Leonardi, J. C. Zanardi, and G. Condous. "VP05.09: Anatomical distribution of deep endometriosis on transvaginal ultrasound and clinical features: implications on non‐invasive diagnosis." Ultrasound in Obstetrics & Gynecology 58, S1 (October 2021): 113. http://dx.doi.org/10.1002/uog.24094.
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Perricos, Alexandra, René Wenzl, Heinrich Husslein, Thomas Eiwegger, Manuela Gstoettner, Andreas Weinhaeusel, Gabriel Beikircher, and Lorenz Kuessel. "Does the Use of the “Proseek® Multiplex Oncology I Panel” on Peritoneal Fluid Allow a Better Insight in the Pathophysiology of Endometriosis, and in Particular Deep-Infiltrating Endometriosis?" Journal of Clinical Medicine 9, no. 6 (June 26, 2020): 2009. http://dx.doi.org/10.3390/jcm9062009.
Анотація:
Endometriosis appears to share certain cancer-related processes, such as cell attachment, invasion, proliferation and neovascularization, some of which can also be found in other healthy tissues. In order to better understand the altered milieu of the peritoneal cavity, while acknowledging the reported similarities between endometriosis and neoplastic processes, we applied a multiplex oncology panel to search for specific biomarker signatures in the peritoneal fluid of women with endometriosis, women with deep-infiltrating endometriosis (DIE), as well as controls. In total, 84 patients were included in our study, 53 women with endometriosis and 31 controls. Ninety-two proteins were measured in prospectively collected peritoneal fluid (PF) samples, using the “Proseek® Multiplex Oncology I Panel”. We first compared patients with endometriosis versus controls, and in a second step, DIE versus endometriosis patients without DIE. Out of the 92 analyzed proteins, few showed significant differences between the groups. In patients with endometriosis, ICOS ligand, Endothelial growth factor, E-selectin, Receptor tyrosine-protein kinase erbB-2, Interleukin-6 receptor alpha, Vascular endothelial growth factor receptor 2, Fms-related tyrosine kinase 3 ligand, C-X-C motif chemokine 10, Epididymal secretory protein E4 and Folate receptor-alpha were decreased, while Interleukin-6 and Interleukin-8 were increased compared to controls. Looking at patients with DIE, we found Chemokine ligand 19, Stem cell factor, Vascular endothelial growth factor D, Interleukin-6 receptor alpha and Melanoma inhibitory activity to be increased compared to endometriosis patients without DIE. We have shown a distinct regulation of the immune response, angiogenesis, cell proliferation, cell adhesion and inhibition of apoptosis in PF of patients with endometriosis compared to controls. The specific protein pattern in the PF of DIE patients provides new evidence that DIE represents a unique entity of extrauterine endometriosis with enhanced angiogenetic and pro-proliferative features.
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Roman, Horace, Jean-Jacques Tuech, Emmanuel Huet, Valérie Bridoux, Haitham Khalil, Clotilde Hennetier, Michael Bubenheim, and Lacramioara Aurelia Brinduse. "Excision versus colorectal resection in deep endometriosis infiltrating the rectum: 5-year follow-up of patients enrolled in a randomized controlled trial." Human Reproduction 34, no. 12 (December 1, 2019): 2362–71. http://dx.doi.org/10.1093/humrep/dez217.
Анотація:
Abstract STUDY QUESTION Is there a difference in functional outcomes and recurrence rate between conservative versus radical rectal surgery in patients with large deep endometriosis infiltrating the rectum 5 years postoperatively? SUMMARY ANSWER No evidence was found that long-term outcomes differed when nodule excision was compared to rectal resection for deeply invasive endometriosis involving the bowel. WHAT IS KNOWN ALREADY Functional outcomes of nodule excision and rectal resection for deeply invasive endometriosis involving the bowel are comparable 2 years after surgery. Despite numerous previously reported case series enrolling patients managed for colorectal endometriosis, long-term data remain scarce in the literature. STUDY DESIGN, SIZE, DURATION From March 2011 to August 2013, we performed a two-arm randomized trial, enrolling 60 patients with deep endometriosis infiltrating the rectum up to 15 cm from the anus, measuring >20 mm in length, involving at least the muscular layer in depth, and up to 50% of rectal circumference. Among them, 55 women were enrolled at one tertial referral centre in endometriosis, using a randomization list drawn up separately for this centre. Institute review board approval was obtained to continue follow-up to 10 years postoperatively. One patient requested to stop the follow-up 2 years after surgery. PARTICIPANTS/MATERIALS, SETTING, METHODS Patients underwent either nodule excision by shaving or disc excision, or segmental resection. Randomization was performed preoperatively using sequentially numbered, opaque, sealed envelopes, and patients were informed of randomization results. The primary endpoint was the proportion of patients experiencing one of the following symptoms: constipation (1 stool/>5 consecutive days), frequent bowel movements (≥3 stools/day), anal incontinence, dysuria or bladder atony requiring self-catheterization 24 months postoperatively. Secondary endpoints were values taken from the Knowles–Eccersley–Scott-symptom questionnaire (KESS), the gastrointestinal quality of life index (GIQLI), the Wexner scale, the urinary symptom profile (USP) and the Short Form 36 Health Survey (SF36). MAIN RESULTS AND THE ROLE OF CHANCE Fifty-five patients were enrolled. Among the 27 patients in the excision arm, two were converted to segmental resection (7.4%). One patient managed by segmental resection withdrew from the study 2 years postoperatively, presuming that associated pain of other aetiologies may have jeopardized the outcomes. The 5 year-recurrence rate for excision and resection was 3.7% versus 0% (P = 1), respectively. For excision and resection, the primary endpoint was present in 44.4% versus 60.7% of patients (P = 0.29), respectively, while 55.6% versus 53.6% of patients subjectively reported normal bowel movements (P = 1). An intention-to-treat comparison of overall KESS, GIQLI, Wexner, USP and SF36 scores did not reveal significant differences between the two arms 5 years postoperatively. Statistically significant improvement was observed shortly after surgery with no further improvement or impairment recorded 1–5 years postoperatively. During the 5-year follow-up, additional surgical procedures were performed in 25.9% versus 28.6% of patients who had undergone excision or resection (P = 0.80), respectively. LIMITATIONS, REASONS FOR CAUTION The presumption of a 40% difference concerning postoperative functional outcomes in favour of nodule excision resulted in a lack of power for demonstration of the primary endpoint difference. WIDER IMPLICATIONS OF THE FINDINGS Five-year follow-up data do not show statistically significant differences between conservative and radical rectal surgery for long-term functional digestive and urinary outcomes in this specific population of women with large involvement of the rectum. STUDY FUNDING/COMPETING INTEREST(S) No specific funding was received. Patient enrolment and follow-up until 2 years postoperatively was supported by a grant from the clinical research programme for hospitals in France. The authors declare no competing interests related to this study. TRIAL REGISTRATION NUMBER This randomized study is registered with ClinicalTrials.gov, number NCT 01291576. TRIAL REGISTRATION DATE 31 January 2011. DATE OF FIRST PATIENT’S ENROLMENT 7 March 2011.
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Noël, Jean-Christophe, Charles Chapron, Isabelle Fayt, and Vincent Anaf. "Lymph node involvement and lymphovascular invasion in deep infiltrating rectosigmoid endometriosis." Fertility and Sterility 89, no. 5 (May 2008): 1069–72. http://dx.doi.org/10.1016/j.fertnstert.2007.05.011.
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Gianardi, Desirée, and Andrea Giannini. "Minimally invasive surgery for deep-infiltrating endometriosis and its impact on fertility: can robotic surgery play a role?" Journal of Robotic Surgery 13, no. 6 (June 3, 2019): 789–90. http://dx.doi.org/10.1007/s11701-019-00981-8.
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Crispi, Claudio Peixoto, Claudio Peixoto Crispi, Bruna Rafaela Santos de Oliveira, Nilton de Nadai Filho, Fernando Maia Peixoto-Filho, and Marlon de Freitas Fonseca. "Six-month follow-up of minimally invasive nerve-sparing complete excision of endometriosis: What about dyspareunia?" PLOS ONE 16, no. 4 (April 23, 2021): e0250046. http://dx.doi.org/10.1371/journal.pone.0250046.
Анотація:
Study objective To assess individual changes of deep dyspareunia (DDyspareunia) six months after laparoscopic nerve-sparing complete excision of endometriosis, with or without robotic assistance. Methods This preplanned interdisciplinary observational study with a retrospective analysis of intervention enrolled 126 consecutive women who underwent surgery between January 2018 and September 2019 at a private specialized center. Demographics, medical history and surgery details were recorded systematically. DDyspareunia (primary outcome), dysmenorrhea and acyclic pelvic pain were assessed on self-reported 11-point numeric rating scales both preoperatively and at six-month follow-up. Cases with poor prognosis in relation to dyspareunia were described individually in greater detail. Results Preoperative DDyspareunia showed weak correlation with dysmenorrhea (rho = .240; P = .014) and pelvic pain (rho = .260; P = .004). Although DDyspareunia improved significantly (P < .001) by 3 points or more in 75.8% (95%CI: 64.7–86.2) and disappeared totally in 59.7% of cases (95%CI:47.8–71.6), individual analysis identified different patterns of response. The probability of a preoperative moderate/severe DDyspareunia worsening more than 2 points was 4.8% (95%CI: 0.0–10.7) and the probability of a woman with no DDyspareunia developing “de novo” moderate or severe DDyspareunia was 7.7% (95%CI: 1.8–15.8) and 5.8% (95%CI: 0.0–13.0), respectively. In a qualitative analysis, several conditions were hypothesized to impact the post-operative DDyspareunia response; these included adenomyosis, mental health disorders, lack of hormone therapy after surgery, colporrhaphy, nodule excision in ENZIAN B compartment (uterosacral ligament/parametrium), the rectovaginal septum or the retrocervical region. Conclusion Endometriosis surgery provides significant improvement in DDyspareunia. However, patients should be alerted about the possibility of unsatisfactory results.
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Vallvé-Juanico, Júlia, Cristian Barón, Elena Suárez-Salvador, Josep Castellví, Agustín Ballesteros, Antonio Gil-Moreno, and Xavier Santamaria. "Lgr5 Does Not Vary Throughout the Menstrual Cycle in Endometriotic Human Eutopic Endometrium." International Journal of Molecular Sciences 20, no. 1 (December 21, 2018): 22. http://dx.doi.org/10.3390/ijms20010022.
Анотація:
Endometriosis is characterized by the abnormal presence of endometrium outside of the uterus, resulting in pelvic pain and infertility. The leucine-rich repeat-containing G protein-coupled receptor 5 (LGR5) has been postulated to be a marker of stem cells in the endometrium. However, LGR5+ cells have a macrophage-like phenotype in this tissue, so it is unclear what role LGR5+ cells actually play in the endometrium. Macrophages serve an important function in the endometrium to maintain fertility, while LGR5+ cells generally have a role in tumor progression and are involved in invasion in some cancers. We sought to determine whether LGR5+ cells vary across the menstrual cycle in women with endometriosis and whether there are implications for LGR5 in the aggressiveness of endometriosis and reproductive outcomes. We performed immunofluorescence, flow cytometry, and primary culture in vitro experiments on eutopic and ectopic endometrium from healthy and endometriosis patients and observed that neither LGR5+ cells nor LGR5 expression varied throughout the cycle. Interestingly, we observed that LGR5+ cell percentage overexpressing CD163 (anti-inflammatory marker) was higher in healthy endometrium, suggesting that in endometriosis, endometrium presents a more pro-inflammatory phenotype that likely leads to poor obstetric outcomes. We also observed higher levels of LGR5+ cells in ectopic lesions compared to eutopic endometrium and specifically in deep infiltrating endometriosis, indicating that LGR5 could be involved in progression and aggressiveness of the disease.