Laparoscopic excision of deeply infiltrating endometriosis: a prospective observational study assessing perioperative complications in 244 patients

  • Shaheen KhazaliEmail author
  • Atefeh Gorgin
  • Arash Mohazzab
  • Roxana Kargar
  • Roya Padmehr
  • Khadije Shadjoo
  • Vasilis Minas
General Gynecology



To examine peri-operative complications in patients undergoing laparoscopic excision of deeply infiltrating endometriosis (DIE).


This was a prospective study of a case series of women having laparoscopic excision of deeply infiltrating endometriosis from September 2013 through August 2016 in a tertiary referral center for endometriosis and minimally invasive gynaecological surgery in Iran. Data collected included demographics, baseline characteristics, intraoperative and postoperative data up to 1 month following surgery.


We analysed data from 244 consecutive patients, who underwent radical laparoscopic excision of all visible DIE. Major postoperative complications occurred in 3 (1.2%) and minor complications in 27 (11.1%) of patients. 80.3% of our patient group had Stage IV endometriosis. Segmental bowel resection was performed in 34 (13.9%), disc resection in 7 (2.9%), rectal shave in 53 (21.7%). Joint operating between a gynaecologist and colorectal and/or urological colleague was required in 29.6% of cases. The mean operating time was 223.8 min (± 80.7 standard deviation, range 60–440 min) and mean hospital stay was 2.9 days (± 1.5 standard deviation, range 1–11). The conversion to laparotomy rate was 1.6%.


A combination of different laparoscopic surgical techniques to completely excise all visible DIE, within the context of a tertiary referral center offering multi-disciplinary approach, produces safe outcomes with low complication rates.


Laparoscopic treatment of endometriosis Deeply infiltrating endometriosis Recto-vaginal endometriosis Surgical complications Multi-disciplinary team 


Author contribution

SK: Project development, Lead surgeon, Manuscript writing and editing, Data analysis. AG: Surgeon, Manuscript writing, Data collection, management and analysis. AM: Database design, project coordination, Data analysis. RK: Surgeon, Data collection. RP: Surgeon, Data collection. KS: Surgeon, Data collection. VM: Data analysis, Manuscript writing and editing


No external funding was used for this study.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare.

Ethical approval

All procedures performed were in accordance with the ethical standards of the Ethics Committee of the Avicenna Research Institute, affiliated to the Academic Center for Education, Culture and Research (ACECR) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards (Ethical Committee approval number IR.ACECR.Avicenna.REC.1395.1).

Informed consent

Informed consent was obtained from all patients included in the study. No minors were included in this study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Shaheen Khazali
    • 1
    • 2
    • 3
    Email author
  • Atefeh Gorgin
    • 2
  • Arash Mohazzab
    • 2
  • Roxana Kargar
    • 2
  • Roya Padmehr
    • 2
  • Khadije Shadjoo
    • 2
  • Vasilis Minas
    • 1
  1. 1.Centre for Endometriosis and Minimally Invasive Gynaecology (CEMIG), Ashford & St. Peter’s Hospital NHS Foundation TrustChertseyUK
  2. 2.Avicenna Centre for Endometriosis and Minimally Invasive Gynaecology (ACEMIG)Avicenna Research Institute, ACECRTehranIran
  3. 3.Royal Holloway-University of LondonEghamUK

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