Laparoscopic treatment of deeply infiltrating endometriosis with diode laser: a pilot study

Background Deep infiltrating endometriosis is defined by the European Society of Human Reproduction and Embryology (ESHRE) as a peritoneal infiltration of more than 5 mm deep by the endometrial tissue. DIE frequently presents with nodules involving the rectovaginal space, the bladder, pelvic nerves, ureters, and/or the bowel and rarely other locations like abdominal wall or thorax. Many studies agree that surgical resection of DIE improves pain, quality of life. A wide range of surgical procedures may be adopted for the management of DIE in particular to perform excision of nodules from ureter and bowel. Cold scissor, plasma energy or CO2 lasers have been proposed and it seems that in expert hands they achieve good results and low complications rates. Recently diode lasers have been proposed in endoscopic gynecological surgery. The aim of this study was to assess the feasibility, safety and efficacy of the diode laser in the treatment of deep infiltrating endometriosis. Methods This Pilot study included 25 women with DE diagnosed in the Endometriosis and Chronic pelvic pain Centre of the University of Cagliari between November 2017 and November 2018.Before the surgery they presented following symptoms : pregnancy wish, chronic pelvic pain, dysmenorrhea, dyspareunia, dyschezia, dysuria and 15 of them reported previous surgical treatments without employment. Clinical patient characteristics including age, body mass index (BMI), pre-surgical clinical staging, visual analog score for chronic pain measurement, comorbidity, prior abdominal surgery, and intraoperative parameters including operative time, blood loss, conversion rate, and complications were recorded. Postoperative parameters included short-term (within 30 days of the procedure) complications and length of hospital stay. Complications were measured by the Clavien-Dindo scaleIn detail, during the laparoscopic surgery were performed using the DWLS, with a conic fiber of 1000 micron (Biolitec®, Leonardo®, wavelength of 980 nm and 1470 nm): 20 adhesiolysis, 20 uretolysis, 2 ureter stent, 10 cistectomy, 3 high rectosigmoid resection (with end-to-end anastomosis) and 15 resection of posterior fornix. Results Median patients’ age was 31 (range 22–42), and body mass index was 23 kg/m2 (range 21–33). The mean operative time was 155 min (range 112–175). No intraoperative complications and early complications (< 30 days) occurred, and all patients were discharged within 3 days mean ( range 2-8 days) of surgery. Improvement of pain was statistically significative at three months follow-up. Conclusions Diode laser seems to be another useful device for endometriosis treatment. The shaving surgical approach with a diode laser system leads to a safe and effective laparoscopic dissection of deep endometriotic lesions. The results in term of efficacy and pregnancy outcomes need further larger randomized studies.