Table of Contents
ISRN Obstetrics and Gynecology
Volume 2014 (2014), Article ID 853902, 8 pages
Clinical Study

Posterior Deep Infiltrating Endometriotic Nodules: Operative Considerations according to Lesion Size, Location, and Geometry, during One’s Learning Curve

1st Department of Obstetrics and Gynecology, University of Athens, “Alexandra” Hospital, 3 Aisopou Street, Marousi, 15122 Athens, Greece

Received 23 August 2013; Accepted 27 October 2013; Published 20 January 2014

Academic Editors: F. Carmona and C. Petta

Copyright © 2014 Athanasios Protopapas et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


We conducted this prospective cohort study to standardize our laparoscopic technique of excision of posterior deep infiltrating endometriosis (DIE) nodules, according to their size, location, and geometry, including 36 patients who were grouped, according to principal pelvic expansion of the nodule, into groups with central (group 1) and lateral (group 2) lesions, and according to nodule size, into ≤2 cm (group A) and >2 cm (group B) lesions, respectively. In cases of group 1 the following operative steps were more frequently performed compared to those of group 2: suspension of the rectosigmoid, colpectomy, and placement of bowel wall reinforcement sutures. The opposite was true regarding suspension of the adnexa, systematic ureteric dissection, and removal of the diseased pelvic peritoneum. When grouping patients according to nodule size, almost all of the examined parameters were more frequently applied to patients of group B: adnexal suspension, suspension of the rectosigmoid, systematic ureteric dissection, division of uterine vein, colpectomy, and placement of bowel wall reinforcement sutures. Nodule size was the single most important determinant of duration of surgery. In conclusion, during the building-up of one’s learning curve of laparoscopic excision of posterior DIE nodules, technique standardization is very important to avoid complications.