Effectiveness of laparoscopic surgeries in treating infertility related to endometriosis

Słabuszewska-Jóźwiak, Aneta; Ciebiera, Michał; Baran, Arkadiusz; Jakiel, Grzegorz

doi:10.5604/12321966.1152089

Cited by 18 publications

(33 citation statements)

References 24 publications

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“…For the treatment of endometriosis, minimally invasive surgery is an important option along with hormonal treatment . Laparoscopic surgery is proven to relieve pain and to improve fertility in women with endometriosis, but a complete removal of all lesions is decisive for pain relief and for fertility . Moreover, there is evidence that postoperative recurrence of endometriosis may be due to incomplete resection during the initial surgery …”

Section: Introductionmentioning

confidence: 99%

Visualization of endometriosis with laparoscopy and near‐infrared optics with indocyanine green

Siegenthaler

Knabben

Mohr

et al. 2020

Acta Obstet Gynecol Scand

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Introduction:Endometriosis is a common health problem, affecting 10% of women of reproductive age. Laparoscopic surgery is proven to relieve pain and to improve fertility in women with endometriosis. However, identifying peritoneal endometriosis lesions may be difficult due to their polymorphic aspects. Endometriosis lesions harbor a high degree of neovascularization. The visualization of tissue perfusion by the additional use of near infrared fluorescence imaging with indocyanine green (ICG) may improve the detection of endometriosis lesions. Material and methods:In a single-center, prospective, single-arm pilot study, patients undergoing laparoscopic surgery for suspected endometriosis and/or infertility were recruited. All patients first had white light imaging with systematical documentation of all suspicious areas. ICG was then administered intravenously at .3 mg/kg bodyweight and the near infrared imaging was activated and an identical documentation of suspected lesions was performed again. After removal, the specimen were sent to pathology. Clinical trial registration: clinicaltrials.gov NCT03850158. Results:In total, 173 suspected lesions were identified and excised, of which 150 had histologically proven endometriosis. Of the total number, 166 suspected lesions were detected using white-light and 32 with ICG. Among the 32 suspected lesions found with ICG, 22 were confirmed to be endometriosis. Seven additional lesions were identified with ICG alone, of which only one was histologically proven endometriosis. Positive predictive values were 89.8%, 68.8% and 86.7% for white-light laparoscopy alone, near-infrared (NIR)-ICG visualization alone, and the combination of white-light and NIR-ICG, respectively. ICG exposure time, previous abdominal surgery and rARSM stage showed a statistically significant impact on the ICG detection rate. In seven patients, ICG was used for the resection of deep infiltrating nodules from the rectum. In these cases, NIR fluorescence imaging with ICG was useful to define the borders between an endometriotic nodule and healthy tissue. Conclusions: The diagnostic value of NIR-ICG imaging in identifying endometriosis appears to be minimal. ICG exposure time over 20 minutes, no previous abdominal Preoperative symptoms, n (%) Pain 45 (71.4) Infertility 4 (6.3) Both 13 (20.6) Prior surgery for endometriosis, n (%) 34 (54.0) Previous abdominal surgery, n (%) 40 (63.5) Preoperative hormonal treatment, n (%) 38 (60.3) Abbreviations: n, number of patients; SD, standard deviation; rASRM, revised American Society for Reproductive Medicine.

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Section: Introductionmentioning

confidence: 99%

Visualization of endometriosis with laparoscopy and near‐infrared optics with indocyanine green

Siegenthaler

Knabben

Mohr

et al. 2020

Acta Obstet Gynecol Scand

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“…The average time from the date of surgical procedure to spontaneous pregnancy amounted to 6 months. 12 In present study, 69 (86.35%) of patients had primary infertility while 11 (13.75%) of patients had secondary infertility.…”

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confidence: 86%

Reproductive surgery in infertility

Sud¹,

Sud²,

Upadhye³

2017

Int J Reprod Contracept Obstet Gynecol

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Background: With recent improvements in the assisted reproductive technology (ART), there has been a growing tendency that bypasses diagnostic laparohysteroscopy and proceeds directly to ART. Therefore, the value of diagnostic laparohysteroscopy in current fertility practice is under debate. In the present study, we evaluated the usefulness of diagnostic laparoscopy and hysteroscopy for patients with infertility.Methods: This retrospective study was conducted at Safal Hospital, Nagpur from January 2017 to July 2017. 80 patients were selected for this study who had undergone diagnostic laparohysteroscopy for infertility.Results: In present study, out of 80 patients studied, 66.25% patients had normal hysteroscopy findings, in 10% of patients, tubal cannulation was done for cornual block, in 6.25% of patients, resection of uterine septum was done, adhesiolysis for asherman’s syndrome was done in 5% of patients, endometrial polyp was removed in 5% of patients, 2.5% patients had resection of submucous fibroid. In 5% patients, cervical dilatation for fibrosis was done in 5% of patients. 68.75% had normal laparoscopy findings, in 8.75% of patients, ovarian drilling for PCOS was done, adhesiolysis for peritubal adhesions was done in 6.25% patients, fulguration of endometriosis was done in 6.25% patients, salpingectomy for hydrosalpinx was done in 5% patients, aspiration of ovarian cyst was done in 2.5% patients.Conclusions: Diagnostic hysterolaparoscopy is an effective diagnostic and therapeutic modality for certain significant and correctable abnormalities in pelvis, tubes and uterus which are missed by other imaging modalities.

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“…In endometriosis, the ectopic endometrial tissue is morphologically similar to normal endometrium and it responds to ovarian hormones during cyclical changes similar to eutopic endometrium [11].…”

Section: Pathogenesismentioning

confidence: 99%

“…Endometriosis has four stages or types: stage I, minimal, with small lesions and shallow endometrial implants on the ovary; stage 2, mild, with light lesions and shallow implants on the ovary and the pelvic lining; stage 3, moderate, with deep and more implants on the ovary and pelvic lining; and stage 4, severe, with deep implants on the pelvic lining and ovaries [1][2][3][4][5][6][7][8][9][10][11].…”

Section: Diagnosis and Evolutionmentioning

confidence: 99%

Endometriosis: When and How We Treat

Saceanu¹,

Pătrașcu²,

Pătraşcu³

et al. 2017

Fertility-Oriented Female Reproductive Surgery

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Endometriosis is a chronic, nonmalignant and estrogen-dependent disease in which endometrial glandular epithelium and stroma are outside the uterine cavity (ovaries, peritoneum, or rectovaginal septum). The prevalence is estimated from 2 to 10% in women of childbearing age and it rises up to 50% in women with infertility. Despite maximal efforts, the therapy of first choice in the management of endometriosis is still unclear. The aim of this chapter is to present an update of its management, emphasizing the benefits and disadvantages of surgical methods. We performed a systematic literature search on the PubMed database of English literature (search terms: endometrioma, surgery, ovarian reserve, assisted reproductive technologies) from 2010 to 2014. For endometrioma, operative laparoscopy proved to be the gold standard. Surgical procedures consist of partial excision of the cyst wall and electro-coagulation of the rest. Stripping technique may be a better method for reducing the recurrence of pain symptoms, recurrence, and reoperation rates, but it raises concerns about ovarian reserve. For endometriosis, surgery often includes partial rectum or sacrouterine ligament resection. Hysterectomy is not obligatory and refused by the young patients. The approach should be laparoscopic and if necessary vaginal assisted. Good cooperation between various disciplines (gynecology, surgery, urology) is mandatory.

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Effectiveness of laparoscopic surgeries in treating infertility related to endometriosis

Cited by 18 publications

References 24 publications

Visualization of endometriosis with laparoscopy and near‐infrared optics with indocyanine green

Visualization of endometriosis with laparoscopy and near‐infrared optics with indocyanine green

Reproductive surgery in infertility

Endometriosis: When and How We Treat

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