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Endometriosis Resection Using Nerve Sparing Versus Non-nerve Sparing Surgical Techniques

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Abstract

Introduction

Endometriosis is the condition in which there are ectopic endometrial tissues outside the uterine cavity. The use of nerve sparing technique has been well established in the field of oncology, leading to better quality of life following radical oncologic procedures without compromising on the long-term survival. The objective of this study is to compare the quality of life in terms of sexual function and urinary function in women undergoing nerve sparing surgeries for endometriosis and those undergoing non-nerve sparing surgeries.

Material and Methods

Data of 51 patients operated for endometriosis at Galaxy Care Laparoscopic Institute, Pune, India between 1st January 2020 till 31st December 2020 were collected and analysed. We included patients in age group between 38 and 44 years in monogamous relationship, with moderate to severe endometriosis (Revised American Society of Reproductive Medicine r-ASRM score of 16 and above 5), being operated for hysterectomy along with ureterolysis and/or bowel resection (including shaving of rectal endometriosis, discoid resection, segmental resection), and excision of large ovarian endometriomas (> 3 cm size) with cul-de-sac obliteration.

Results

The patients were evaluated for the following factors: age, parity, nature of surgery done, immediate intraoperative complications (bowel injury, bladder injury, ureteric injury), operative time in minutes, average blood loss, length of hospital stay, days to removal of foley’s catheter and postoperative urinary and sexual function which were assessed on follow up visit and a 1-year follow up interview. We found that the urinary and sexual function in the group undergoing nerve sparing surgeries was significantly better than the patients undergoing non-nerve sparing surgeries.

Conclusion

Laparoscopic nerve sparing approach for clearance of endometriosis has allowed better quality of life post surgery. Proper understanding and demonstration of pelvic neuroanatomy has made this approach feasible and achievable in carefully selected patients.

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Authors and Affiliations

  1. Galaxy Care Laparoscopy Institute, Pune, India

    Shailesh P. Puntambekar, Sneha Venkateswaran, Saranya Naidu, Maitreyee Parulekar, Madhavi Patil, Sravya Inampudi, Mihir Chitale, Suyog Bharambe, Aishwarya Puntambekar, Kshitij Manerikar & Seema Puntambekar

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  1. Shailesh P. Puntambekar
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  2. Sneha Venkateswaran
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Correspondence to Shailesh P. Puntambekar.

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Ethical Standards

This is a prospective study involving human participants and was in accordance with the ethical standards of the institutional ethics committee and with the 1964 Helsinki Declaration and its later amendments.

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Dr. Shailesh P Puntambekar (MS) is an Medical Director; Dr. Sneha Venkateswaran (MS, DNB (OBGY)) is an Fellow in Minimal Access Surgery – Gynaecology; Dr. Saranya Naidu (DGO, DNB (OBGY)) is an Fellow in Minimal Access Surgery; Dr. Maitreyee Parulekar (MS (OBGY)) is an Fellow in Minimal Access Surgery – Gynaecology; Dr. Madhavi Patil (DGO, DNB (OBGY)) is an Fellow in Minimal Access Surgery – Gynaecology; Dr. Sravya Inampudi (MS) is an Fellow in Minimal Access Surgery; Dr. Mihir Chitale (DNB, FMAS) is an Consultant Surgeon; Dr. Suyog Bharambe (MS, FMAS) is an Consultant Surgeon; Dr. Aishwarya Puntambekar (MS) is an Fellow in Minimal Access Surgery; Dr. Kshitij Manerikar (MS) is an Consultant Surgeon; Dr. Seema Puntambekar (MD, DGO) is an Consultant Gynaecologist and Chief Medical Admin.

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Puntambekar, S.P., Venkateswaran, S., Naidu, S. et al. Endometriosis Resection Using Nerve Sparing Versus Non-nerve Sparing Surgical Techniques. J Obstet Gynecol India 73, 421–427 (2023). https://doi.org/10.1007/s13224-023-01794-4

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