Endometriosis is a common disease of the gynecologic organs characterized by the presence of ectopic endometrial glands and stroma. It affects roughly 18% of the overall menstruating population, and up to 42% of those with chronic pelvic pain (1). Parametrial endometriosis (PE) is a specific presentation of deeply infiltrating endometriosis that infiltrates the parametria laterally towards the pelvic sidewall. It has been associated with severe pelvic pain and pelvic dysfunction, as well as a reduction in the quality of life of the patients whom it affects. In spite of these effects, it is not a well-defined etiology, and it is likely underdiagnosed using traditional sonography, and was omitted from the 2016 consensus to standardize the nomenclature of ultrasonographic pelvic evaluation in women published by the  International Deep Endometriosis Analysis (IDEA) group (2). It has consequently not been a traditional target in excisional surgery, and the presence of persistent parametrial disease after laparoscopy may be a cause of continued pelvic pain following surgical treatment (3).  

The objective of this study is to characterize the clinical presentation of patients with PE and assess the outcomes of the LaNSURe treatment strategy.

This is a retrospective cohort study involving 54 individuals who underwent unilateral or bilateral parametrectomy for treatment of their endometriosis using the LaNSURe technique. Pain scores were assessed pre-operatively using several validated pain scales, including the Visual Analogue Scale (VAS), McGill Pain Questionnaire, and the Pain Catastrophizing scale. Questionnaires were repeated at intervals post-operatively. The primary outcome was average VAS scores before surgery and at the last postoperative visit.

54 patients were identified for inclusion. Mean post-operative follow-up time was 4.0+3.32 months. 

The average VAS post-surgery significantly decreased from a mean preoperative score of 5.6+2.02 to 2.9+2.3 post-operatively (p=0.002). The maximum pain felt during an endometriosis flare decreased from 8.0+2.4 to 4.8+3.1; (p=0.003). McGill Pain Questionnaire scores decreased from 36.4±18.7 to 19.0±15.7 (p=0.02). Pain Catastrophizing Scale scores decreased from 27.7±14.5 to 14.4±14.9 (p=0.005).

Following excisional surgery using the LaNSURe technique, pain and quality of life scores improved significantly in every validated scale used. This reinforces the need for an elevated diagnostic criteria and modalities, and access to nerve sparing radical resection techniques like the LaNSURe, administered by surgeons with enhanced skills in operative endometriosis.

The LaNSURe technique is effective at improving overall pain and quality of life while preserving nerve function in the pelvic floor. In cases of persistent pelvic pain following traditional excisional surgery for endometriosis, parametrial involvement should be considered.

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Barra, F., Zorzi, C., Albanese, M., Stepniewska, A., Deromemaj, X., De Mitri, P., Roviglione, G., Clarizia, R., Gustavino, C., Ferrero, S., & Ceccaroni, M. (2023). Ultrasonographic Findings Indirectly Predicting Parametrial Involvement in Patients with Deep Endometriosis: The ULTRA-PARAMETRENDO I Study. Journal of minimally invasive gynecology, 30(1), 61–72.
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