Athanasios Protopapas*, Themistoklis Grigoriadis and Stavros Athanasiou
Department of Obstetrics & Gynecology, University of Athens, GreeceFulltext PDF
Endometriosis including deep infiltrative disease affects mainly women of reproductive age. The majority of these women requiring surgery are treated with fertility-sparing procedures. Hysterectomy is reserved for patients with advanced endometriosis and severe pain symptoms and those with recurrences, for whom the open approach is the usual choice. For patients with deep endometriosis total laparoscopic hysterectomy may represent a safe and valid option providing that a more extended operation in comparison with standard laparoscopic hysterectomy is practiced, to address also deep nodules. Important prerequisites for a surgeon to undertake such procedures are thorough knowledge of pelvic retroperitoneal anatomy, advanced laparoscopic skills, and experience in pelvic radical surgery. This procedure should aim for a complete removal of all deep lesions using a multi-disciplinary approach when necessary. Incomplete surgery is associated with an increased risk of postmenopausal anatomic relapse, recurrence of pain symptoms, and postmenopausal complications. Hormone replacement therapy after hysterectomy and ovarian conservation are among the most important risk factors for recurrence and re-operation. There is also a theoretical risk of a malignancy developing in residual deep lesions that is difficult to quantify.
Protopapas A, Grigoriadis T, Athanasiou S. Total Laparoscopic Hysterectomy in Patients with Deep Infiltrative Endometriosis: How Different is it, or should be, from the Standard Procedure? Clin Surg. 2018; 3: 2235.