Endometriosis

Olympus is striving to provide innovative minimally invasive solutions in the field of endometriosis treatment.

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Deep Infiltrating Endometriosis Treatment

A versatile Energy Device

The removal of abdominal and especially rectovaginal and rectosigmoid endometrial lesions, as well as partial bladder and bowel resection, are demanding procedural steps in deep infiltrating endometriosis surgery. 1 2

This requires an energy device that is both safe and versatile. Safe surgery means that the coagulation capabilities, in other words sealing and secondary hemostasis, need to be reliable, but without damaging surrounding vital structures. A versatile energy device, in contrast, needs to be precise in dissection and strong in grasping, but it also needs to be fast to enable an effective operative speed. 3 4 5 6 7

Hybrid Technology in Deep Infiltrating Endometriosis

The advanced energy device THUNDERBEAT Type S unites all these requirements in one single instrument. Its hybrid technology combines:

  • Fast cutting with safe coagulation in the “SEAL & CUT” mode.
  • Sealing, e.g., advanced secondary hemostasis, in the SEAL mode.
  • Minimal thermal spread. 3 4 5 6 7

Recognition of Anatomical Landmarks

The key steps of the radical surgery for deep infiltrating endometriosis (DIE) are the recognition of anatomical landmarks, the performance of a safe dissection of the retroperitoneal spaces, and a precise resection of the disease. During radical pelvic surgeries for DIE, portions of the pelvic visceral nervous system, in particular hypogastric nerves, can be accidentally damaged. This leads to significant visceral dysfunctions, dramatically affecting women’s quality of life. 1 2

Better Visualization of Retroperitoneal Structure with 3D

A laparoscopic 3D view provides a better visualization of the retroperitoneal structure and allows a more accurate evaluation of the distances between the anatomical landmarks. In particular during the dissection of the parametria, the isolation of the hypogastric and the pelvic splanchnic nerve is crucial, in order to reduce the risk of neurovegetative dysfunction. 13 14 15 16 17 18 19 20

Advantages of 3D Imaging during Bowel Resection

During the segmental bowel resection for DIE, the 3D view notably improves the visualization of the presacral and hypogastric fascia. This allows for an avascular dissection of the retrorectal space by sparing as much as possible of the mesorectal vessels.

During the reconstructive step of the ureteroneocystostomy, the depth perception of the 3D view makes a safer and faster manipulation of the needle possible.

Moreover, 3D imaging facilitates precise movements of the surgeon, which is especially advantageous when suturing between the bladder and the ureter. 13 14 15 16 17 18 19 20

Achieving High Quality of Surgery

The laparoscopic endoscope ENDOEYE 3D provides the surgeon with a depth perception that supports him in achieving a high quality of surgery. It also

  • Reduces operating time.
  • Increases confidence during procedures.
  • Reduces the laparoscopic learning curve.
    13 14 15 16 17 18 19 20

ENDOEYE 3D Product Details

Ovarian Endometrioma Surgery with HICURA Laparoscopic Hand Instruments

The presence of ovarian endometriomas has a detrimental impact on the ovarian follicular reserve. As each surgical technique is critical and carries the risk of follicle loss, surgery should be performed meticulously by experienced hands and with safe bipolar instruments such as the HICURA laparoscopic hand instruments. The HICURA modular system comprises different lengths, shafts, handles and jaws to accommodate surgeons needs.

HICURA Product Details

Diagnosis of Superficial Peritoneal Endometriosis

NBI in the Diagnosis of Superficial Peritoneal Endometriosis

Narrow-band imaging (NBI) is an optical technology that uses special narrow-band filters in the endoscopic system. The NBI system has thus far been recognized as a potentially powerful means of diagnosing gastrointestinal diseases, head and neck cancers, urothelial carcinoma of the bladder and precancerous airway lesions. In gynecology, narrow-band imaging has been used to detect peritoneal endometriosis implants during laparoscopy, and some studies have demonstrated that it can be used to identify and remove even small implants. 21 22 23

Before
After

Easy Use of NBI Option

NBI requires no additional equipment or patient preparation other than the Olympus light source, camera head and processor. Converting between whitelight imaging and NBI only requires the press of a button on the laparoscopic stack. 24 25 26

Before
After

Deep Infiltrating Endometriosis

Endometriotic lesions extending more than 5 mm beneath the peritoneum are defined as deep infiltrating lesions. They can be detected on the following pelvic structures and organs:

  • the uterosacral ligaments,
  • the vagina,
  • the bowel,
  • the bladder and the ureters.

Deep bowel endometriosis is defined as the infiltration of the muscular layer of the rectum, rectosigmoid junction or the sigmoid.
27 28 29 30 31

Ovarian Endometrioma

Ovarian endometriomas are present in
17-44% of women with pelvic pain and infertility. 5 6

Surgical procedures include aspiration of the chocolate-colored fluid from the endometrioma, drainage of the cyst followed by bipolar coagulation, fenestration and laser ablation, cystectomy with complete resection of the endometrioma wall, or even oophorectomy in exceptional cases. 32 33 34 35

Superficial Peritoneal Endometriosis

Superficial peritoneal endometriosis (SPE) is the most common type of endometriosis, accounting for approximately 80% of all cases. It can coexist with the other subtypes, as well as with adenomyosis.

Surgical removal of lesions requires appropriate surgical expertise and involves laparoscopic excision and ablation of the endometriotic lesions. 36 37 38

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Sources​

  1. 1.Choosing the right technique for deep endometriosis. Nisolle M, Brichant G, Tebache L. Best Pract Res Clin Obstet Gynaecol. 2019;59:56-65. doi:10.1016/j.bpobgyn.2019.01.010
  2. 2.Conservative surgery versus colorectal resection in deep endometriosis infiltrating the rectum: a randomized trial. Roman H, Bubenheim M, Huet E, et al. Hum Reprod. 2018;33(1):47-57.doi:10.1093/humrep/dex336
  3. 3.Choosing the right surgical technique for deep endometriosis: shaving, disc excision, or bowel resection? Donnez O, Roman H. Fertil Steril. 2017;108(6):931-942. doi:10.1016/j.fertnstert.2017.09.006
  4. 4.Complete laparoscopic excision of endometriosis in teenagers: is postoperative hormonal suppression necessary? Yeung P Jr, Sinervo K, Winer W, Albee RB Jr. Fertil Steril. 2011;95(6):1909-1912.e1. doi:10.1016/j.fertnstert.2011.02.037
  5. 5.Ovarian endometriosis and fertility preservation: a challenge in 2018. Donnez J, García-Solares J, Dolmans MM. Minerva Ginecol. 2018;70(4):408-414. doi:10.23736/S0026-4784.18.04229-6
  6. 6.Association between ovarian endometrioma and ovarian reserve. Kitajima M, Khan KN, Harada A, et al. Front Biosci (Elite Ed). 2018;10:92-102. Published 2018 Jan 1. doi:10.2741/e810
  7. 7.Ovarian function after the use of various hemostatic techniques during treatment for endometrioma: protocol for a randomized clinical trial. Araujo RSDC, Maia SB, Baracat CMF, et al. Trials. 2019;20(1):410. Published 2019 Jul 9. doi:10.1186/s13063-019-3524-z
  8. 8.Ovarian endometrioma - a possible finding in adolescent girls and young women: a mini-review. Gałczyński K, Jóźwik M, Lewkowicz D, Semczuk-Sikora A, Semczuk A. J Ovarian Res. 2019;12(1):104. Published 2019 Nov 7. doi:10.1186/s13048-019-0582-5
  9. 9.Epithelial Mutations in Endometriosis: Link to Ovarian Cancer. Bulun SE, Wan Y, Matei D. Endocrinology. 2019;160(3):626-638. doi:10.1210/en.2018-00794
  10. 10.Modern approaches to surgical management of endometrioma. Gordts S, Campo R. Best Pract Res Clin Obstet Gynaecol. 2019;59:48-55. doi:10.1016/j.bpobgyn.2018.12.013
  11. 11.Surgical removal of superficial peritoneal endometriosis for managing women with chronic pelvic pain: time for a rethink? Horne AW, Daniels J, Hummelshoj L, Cox E, Cooper KG. BJOG. 2019;126(12):1414-1416. doi:10.1111/1471-0528.15894
  12. 12.Surgical Treatment of Endometriosis: Excision Versus Ablation of Peritoneal Disease. Falcone T, Wilson JR. J Minim Invasive Gynecol. 2019;26(1):1-2. doi:10.1016/j.jmig.2018.10.008
  13. 13.Surgical treatment of different types of endometriosis: Comparison of major society guidelines and preferred clinical algorithms. Kho RM, Andres MP, Borrelli GM, Neto JS, Zanluchi A, Abrão MS. Best Pract Res Clin Obstet Gynaecol. 2018;51:102-110. doi:10.1016/j.bpobgyn.2018.01.020
  14. 14.Nerve Sparing and Surgery for Deep Infiltrating Endometriosis: Pessimism of the Intellect or Optimism of the Will. Darwish B, Roman H. Semin Reprod Med 2017;35(1):07280
  15. 15.Nerve-sparing laparoscopic eradication of deep endometriosis with segmental rectal and parametrial resection: The negrar method. Ceccaroni M, Clarizia R, Bruni F, D’Urso E, Gagliardi ML, Roviglione G, et al. A single-center, prospective, clinical trial. Surg Endosc Other Interv Tech 2012;26(7):2029–45.
  16. 16.Randomized Study Comparing Use of THUNDERBEAT Technology vs Standard Electrosurgery during Laparoscopic Radical Hysterectomy and Pelvic Lymphadenectomy for Gynecologic Cancer. Fagotti, A., Vizielli, G., Fanfani, F., Gallotta, V., Rossitto, C., Costantini, B., Gueli-Alletti, S., Avenia, N., Iodice, R., Scambia, G., 2014 May/June. The Journal of Minimally Invasive Gynecology, Volume 21, Issue 3, Pages 447–453.
  17. 17.Minilaparoscopic hysterectomy made easy: First report on alternative instrumentation and new integrated energy platform. Ng, Ying & Lim, Li & Fong, Yoke. (2014). Journal of Obstetrics and Gynaecology Research. 40. 10.1111/jog.12354.
  18. 18.Efficacy and Safety of Combined Ultrasonic and Bipolar Energy Source in Laparoscopic Surgery. Steinemann, Daniel & Lamm, Sebastian & Zerz, Andreas. (2016). Journal of Gastrointestinal Surgery. 20. 10.1007/s11605-016-3217-9.
  19. 19.Evaluation of Vessel Sealing Performance among Ultrasonic Devices in a Porcine Model. Tanaka et al. Surg Innov. 2015 Aug;22(4):338-43. doi: 10.1177/1553350615579730. Epub 2015 Apr 7.
  20. 20.Application of a New Integrated Bipolar and Ultrasonic Energy Device in Laparoscopic Hysterectomies. Lin et al. ISRN Minimally Invasive Surgery (2013)

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