Deep Infiltrating Endometriosis

By Riva Preil

In the past, I have blogged about endometriosis, a condition characterized by the development of endometrial glands outside of the uterine cavity, usually in the superficial peritoneal cavity, on the ovaries, the fossa ovarica, or on the uterosacral ligaments.  The symptoms of endometriosis include severe pelvic pain during one’s period, pain with intercourse, and infertility.  Endometriosis is commonly diagnosed through exploratory laparoscopic surgery which can confirm the presence of lesions, and the symptoms generally improve with menopause or removal of the ovaries.  However, a second version of the disease exists, and it is called deep infiltrating endometriosis (DIE).  The difference between this type of endometriosis and the classic form of the disease is the location and quality of the lesions.  DIE is defined as lesions that exist deeper than 5 mm below the peritoneal surface (usually on the pouch of Douglas or on the uterosacral ligaments), and the lesions are fibromuscular tissue and endometrial glands that look like little nodules.  DIE is considered more aggressive than regular endometriosis, and it may also include pelvic distortion and pain with defecation in addition to the previously mentioned symptoms.

Fortunately, a recent study in Journal of the Society of Laparoendoscopic Surgery (April-June 2013) discovered that robotic assisted laparoscopic colorectal resection (with the da Vinci system- refer to prevous blog, The da Vinci Mode) is an effective and safe surgical option for women suffering from the disease.  The average surgery lasted 157 minutes, and the average hospital stay for women in the study was three days.  Six of the ten women in the study were infertile prior to the surgery.  However, after the surgery, four of those six women were able to conceive naturally, and the remaining two women successfully became pregnant through in vitro fertilization.  Da Vinci strikes again as the many surgical benefits become revealed to the medical community.

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