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Deep infiltrating endometriosis (DIE) in one of the most common reason for surgical treatment due to chronic pelvic pain and/or infertility. The goal of surgery is excision of all visible heterotopias and minimize risk of recurrence of disease and repeated surgeries or improve fertility outcomes. However there are no standardized technique of surgical procedure in DIE. During last 5 year (2010)(2011)(2012)(2013)(2014) we performed 195 laparoscopic operations in patients with DIE with complains of resistant to medical treatment chronic pelvic pain and/or infertility. Our standardized procedure in laparoscopic surgical treatment of DIE include several steps: (1) laparoscopic revision of pelvic and abdominal cavity; (2) adhesiolysis and "second-look" laparoscopic revision, verification of DIE, its localization and stage, ureteres vizualization; (3) surgical treatment of endometriomas (using technique of enucleation and partially ablation); (4) ovarian fixation; (5) lateral peritoneal resection (total or partial); (6) central peritoneal dissection (Duglas dissection with or without vaginal opening and resection of vaginal fornix wall); ( 7) shaving or resection of endometriosis nodules in rectum, bladder, sigmoid colon, ureter, appendectomy if needed; (8) evacuation of macropreparation, inspection of validity of pelvic organs (bladder, rectum, colon); (9) haemostasis and (10) drainage. In our clinic we observed all favorable results of the operations. Rectal shaving was performed in 35 cases, bowel resection in 17, bladder resectionin 10, ureterolysis -in 6, appendectomy -in 11 cases, posterior vaginal fornix resection -in 40 cases. Recurrence of DIE symptoms we detected in 15 patients who did not received or withdrawn postoperative treatment or did not conceive at 12-18 months of observation.Conclusion: standardization of laparoscopic surgical procedure in deep infiltrating endometriosis improves short and long-term results of treatment.

The evolution ways for laparoscopic surgery

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