Nerve-Sparing Technique Said to Cut Complications in Deep Endometriosis


SAN FRANCISCO — A laparoscopic procedure that preserves the hypogastric and pelvic splanchnic nerves appears to reduce urinary retention after treatment of deep pelvic endometriosis, Paulo Ayroza Ribeiro, M.D., reported at the annual meeting of the American Association of Gynecologic Laparoscopists.

In a prospective, nonrandomized study, Dr. Ayroza Ribeiro of Santa Casa Medical School in São Paulo, Brazil, first treated 25 women with laparoscopic radical excision of paracervical deep pelvic endometriosis using standard techniques. Then, after introducing the nerve-sparing technique, he treated an additional 25 women.

Nine of the 25 who underwent the standard procedure experienced urinary retention on day 1 following the operation, 4 still had urinary retention on day 3, and 2 still had urinary retention on day 30.

By comparison, 2 of the 15 women who underwent the nerve-sparing procedure experienced urinary retention on day 1, but all were better by day 3.

The differences in the number of women experiencing urinary retention were statistically significant on day 1, day 3, and day 7 after the procedure.

“Anyone who gets a patient with urinary retention for 30 days, 6 months, 1 year, knows that this is a really great problem,” Dr. Ayroza Ribeiro said at the meeting. “That's why we developed these kind of techniques,” which built upon the work of Marc Possover, M.D., currently of the University of Cologne, Germany.

The new technique starts with a paracervical and pararectal space dissection with identification and preservation of the hypogastric and splanchnic nerves.

It continues with the laparoscopic radical excision of deep pelvic endometriosis using traditional surgical techniques such as blunt dissection and bipolar coagulation.

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