Derin İnfiltratif Endometriozis Cerrahisinde Pelvik Anatomi ve Organlar Nasıl Ortaya Çıkarılır?
Özet
Derin infiltratif endometriozis (DİE), pelvik organlara ve yapılara invazyonu nedeniyle önemli cerrahi zorluklar sunar. Bu bölümde, DİE cerrahisinde pelvik diseksiyon ve organların ortaya çıkarılmasına yönelik kapsamlı bir rehber sunmaktadır. Kişiselleştirilmiş cerrahi planlama için multidisipliner bir ekip ve gelişmiş görüntüleme yöntemlerini içeren ameliyat öncesi değerlendirme çok önemlidir. Tıraşlama, disk rezeksiyonu, segmental rezeksiyon, üreterolize ve nöroliz gibi cerrahi teknikler, DİE lezyonlarının spesifik konumuna ve yayılımına göre uyarlanır. Pelvik organların ve nörovasküler yapıların korunması için detaylı anatomik değerlendirmeler ve titiz diseksiyon teknikleri vurgulanmaktadır. DİE cerrahisi potansiyel komplikasyonlar taşısa da, pelvik anatominin kapsamlı bir şekilde anlaşılması ve cerrahi prensiplere bağlılık,hasta sonuçlarını optimize edebilir ve yaşam kalitesini artırabilir.
Deep infiltrative endometriosis (DIE) presents significant surgical challenges due to its invasion of pelvic organs and structures. This article provides a comprehensive guide to pelvic dissection and organ exposure in DIE surgery.Preoperative assessment, involving a multidisciplinary team and advanced imaging, is crucial for personalized surgical planning. Surgical techniques, including shaving, disk resection, segmental resection, ureterolysis, and neurolysis, are tailored to the specific location and extent of DIE lesions. Detailed anatomical considerations and meticulous dissection techniques are emphasized to preserve pelvic organs and neurovascular structures. While DIE surgery carries potential complications, a thorough understanding of pelvic anatomy and adherence to surgical principles can optimize patient outcomes and improve quality of life.
Referanslar
Pontis, A. Umbilical endometriosis primary site without pelvic endometriosis and previous surgery: A case report. G. Ital. Ostet. Ginecol. 2014, 36, 336–338.
Koninckx, P.R.; Ussia, A.; Adamyan, L.; Tahlak, M.; Keckstein, J.; Wattiez, A.; Martin, D.C. The epidemiology of endometriosis is poorly known as the pathophysiology and diagnosis are unclear. Best Pract. Res. Clin. Obstet. Gynaecol. 2021, 71, 14–26.
Triolo, O.; Laganà, A.S.; Sturlese, E. Chronic Pelvic Pain in Endometriosis: An Overview. J. Clin. Med. Res. 2013, 5, 153–163.
Vercellini, P.; Crosignani, P.; Abbiati, A.; Somigliana, E.; Vigano, P.; Fedele, L. The effect of surgery for symptomatic endometriosis: The other side of the story. Hum. Reprod. Updat. 2009, 15, 177–188.
Becker, C.M.; Bokor, A.; Heikinheimo, O.; Horne, A.; Jansen, F.; Kiesel, L.; King, K.; Kvaskoff, M.; Nap, A.; Petersen, K.; et al. ESHRE guideline: Endometriosis. Hum. Reprod. Open 2022, 2022, hoac009.
Adamson, G.D.; Pasta, D.J. Endometriosis fertility index: The new, validated endometriosis staging system. Fertil. Steril. 2010, 94, 1609–1615.
Dunselman GA, Vermeulen N, Becker C, Calhaz-Jorge C, D'Hooghe T, De Bie B, et al. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014 ;29(3):400-12.
Falcone T, Flyckt R. Clinical management of endometriosis. Obstet Gynecol. 2018 Mar;131(3):557-71.
Ballard K, Lowton K, Wright J. What's the delay? A qualitative study of women's experiences of reaching a diagnosis of endometriosis. Fertil Steril. 2006 Nov;86(5):1296-301. doi: 10.1016/j.fertnstert.2006.04.054. PMID: 17070183.
Zhang X, He T, Shen W. Comparison of physical examination, ultrasound techniques and magnetic resonance imaging for the diagnosis of deep infiltrating endometriosis: A systematic review and meta-analysis of diagnostic accuracy studies. Exp Ther Med. 2020 Oct;20(4):3208-3220. doi: 10.3892/etm.2020.9043. Epub 2020 Jul 24. PMID: 32855690; PMCID: PMC7444323.
Johnson NP, Hummelshoj L, Adamson GD, Keckstein J, Taylor HS, Abrao MS, et al.; World Endometriosis Society Sao Paulo Consortium. World Endometriosis Society consensus on the classification of endometriosis. Hum Reprod. 2017 Feb;32(2):315-324. doi: 10.1093/humrep/dew293. Epub 2016 Dec 5. PMID: 27920089.
Leyland N, Casper R, Laberge P, Singh SS; SOGC. Endometriosis: diagnosis and management. J Obstet Gynaecol Can. 2010 Jul;32(7 Suppl 2):S1-32. PMID: 21545757.
Roman H, Tuech JJ. New disc excision procedure for low and mid rectal endometriosis nodules using combined transanal and laparoscopic approach. Colorectal Dis 2014b; 16:O253 – 256.
Fauconnier A, Chapron C, Dubuisson JB, Vieira M, Dousset B, Bréart G. Relation between pain symptoms and the anatomic location of deep infiltrating endometriosis. Fertil Steril. 2002 Oct;78(4):719-26. doi: 10.1016/s0015-0282(02)03331-9. PMID: 12372446.
Frenna V, Santos L, Ohana E, Bailey C, Wattiez A. Laparoscopic management of ureteral endometriosis: our experience. J Minim Invasive Gynecol. 2007 Mar-Apr;14(2):169-71. doi: 10.1016/j.jmig.2006.09.009. PMID: 17368251.
Darwish B, Roman H. Nerve Sparing and Surgery for Deep Infiltrating Endometriosis: Pessimism of the Intellect or Optimism of the Will. Semin Reprod Med. 2017 Jan;35(1):72-80. doi: 10.1055/s-0036-1597305. Epub 2016 Dec 12. PMID: 27951614.
Kostov S, Slavchev S, Dzhenkov D, Mitev D, Yordanov A. Avascular Spaces of the Female Pelvis-Clinical Applications in Obstetrics and Gynecology. J Clin Med. 2020 May 13;9(5):1460. doi: 10.3390/jcm9051460. PMID: 32414119; PMCID: PMC7291144.
Zanelotti A, Decherney AH. Surgery and Endometriosis. Clin Obstet Gynecol. 2017 Sep;60(3):477-484. doi: 10.1097/GRF.0000000000000291. PMID: 28742580; PMCID: PMC5635831.
Donnez O. Conservative Management of Rectovaginal Deep Endometriosis: Shaving Should Be Considered as the Primary Surgical Approach in a High Majority of Cases. J Clin Med. 2021 Nov 5;10(21):5183. doi: 10.3390/jcm10215183. PMID: 34768704; PMCID: PMC8584847.
Bendifallah S, Puchar A, Vesale E, Moawad G, Daraï E, Roman H. Surgical Outcomes after Colorectal Surgery for Endometriosis: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol. 2021 Mar;28(3):453-466. doi: 10.1016/j.jmig.2020.08.015. Epub 2020 Aug 22. PMID: 32841755.
Nezhat, C., Nezhat, F., & Nezhat, C. Operative gynecologic laparoscopy and hysteroscopy. 2008;Cambridge University Press.
Deguara CS, Pepas L, Davis C. Does minimally invasive surgery for endometriosis improve pelvic symptoms and quality of life? Curr Opin Obstet Gynecol. 2012 Aug;24(4):241-4. doi: 10.1097/GCO.0b013e328355626f. PMID: 22729092.
Jacques Donnez, Jean Squifflet, Complications, pregnancy and recurrence in a prospective series of 500 patients operated on by the shaving technique for deep rectovaginal endometriotic nodules, Human Reproduction, Volume 25, Issue 8, August 2010, Pages 1949–1958, https://doi.org/10.1093/humrep/deq135
Weinberg L, Rao S, Escobar PF. Robotic surgery in gynecology: an updated systematic review. Obstet Gynecol Int. 2011;2011:852061. doi: 10.1155/2011/852061. Epub 2011 Nov 28. PMID: 22190948; PMCID: PMC3236390.
