Clinical analysis of laparoscopic total hysterectomy in patients with complete obliterated Cul-de-Sac due to endometriosis

doi:10.3877/cma.j.issn.1674-6899.2025.04.006

Abstract

Abstract:

Objective

To explore the clinical analysis of laparoscopic total hysterectomy in patients with complete obliterated Cul-de-sac due to endometriosis.

Method

A retrospective analysis was conducted on the general clinical and pathological data of 115 cases of endometriosis diagnosed by postoperative pathology after laparoscopic total hysterectomy from Jun. 2022 to Aug. 2024.Among them, 54 cases had complete obliterated Cul-de-Sac, and 61 cases had incomplete obliterated.The general clinical data and perioperative situation of the two groups were compared.

Result

Both groups did not experience serious complications such as major bleeding, conversion to open surgery, or organ damage.They all recovered well at the 3-month follow-up after surgery. There were more recurrent patients in the completely obliterated group[16 (29.6%) vs. 6 (9.8%), P=0.007], more dysmenorrhea[46(85.2%) vs. 38(62.3%), P=0.006], and younger patients undergoing hysterectomy[45.61±3.96 years vs. 47.41±3.81 years, P=0.015]. The EM resection of ovaries, sacral ligaments, and rectovaginal septum was performed more frequently in the fully obliterated group than in the incompletely obliterated group[35(64.8%) vs.18(29.5%), P<0.001; 42(77.8%) vs.26(42.6%), P<0.001; 46(85.2%) vs. 8(13.1%), P<0.001]; The group with incomplete obliterated of peritoneal EM resection had more cases [22(40.7%) vs. 45(73.8%), P<0.001]. The completely obliterated group had more operation time, intraoperative bleeding, ureteral dissociation and postoperative hospital stay than the incompletely obliterated group 147.00(114.75176.75)min vs. 95.00(81.00117.00)min, P<0.001; 50.00(20.00100.00)ml vs. 20.00(10.00, 20.00)ml, P<0.001; [44(81.5%) vs.15(24.6%), P<0.001; 4.00(3.00, 5.00)d vs. 3.00(2.00, 4.00)d, P<0.001]; There was no significant difference in uterine weight, perioperative ureteral stent placement, postoperative fever, and other complications between the two groups(P>0.05).

Conclusion

Laparoscopic total hysterectomy was performed in patients with endometriosis and complete obliterated Cul-de-Sac, and there were no serious complications occurred during and after the operation, and the postoperative recovery was good, which is a safe, effective and feasible treatment method.

Key words: Endometriosis, Complete Obliteration Cul-de-sac, Laparoscope, Total hysterectomy

Erniao Liu, Fei Miao, Yingfang Zhou, Yan Huang, Lei Zhang, Chao Peng. Clinical analysis of laparoscopic total hysterectomy in patients with complete obliterated Cul-de-Sac due to endometriosis[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2025, 18(04): 222-227.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhqjwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6899.2025.04.006

https://zhqjwkzz.cma-cmc.com.cn/EN/Y2025/V18/I04/222

Figures/Tables 4

References 21

1	中国医师协会妇产科医师分会中华医学会妇产科学分会子宫内膜异位症协作组．子宫内膜异位症诊治指南(第三版)[J]．中华妇产科杂志，2021, 56(12)：812-824.
2	Stone R, Carey E, Fader AN, et al. Enhanced recovery and surgical optimization protocol for minimally invasive gynecologic surgery: an AAGL white paper[J]. J Minim Invasive Gynecol, 2021, 28(2)：179-203.
3	Khong SY, Bignardi T, Luscombe G, et al. Is pouch of Douglas obliteration a marker of bowel endometriosis？[J]. J Minim Invasive Gynecol, 2011, 18(3)：333-337.
4	Arendas K, Coll-Black M, Leyland NA. Approach to the obliterated posterior Cul-De-Sac[J]. J Minim Invasive Gynecol, 2015, 22(6S)：S120.
5	Shirane A, Andou M, Shirane T, et al. Recurrence of endometriosis after laparoscopichysterectomy[J]. Minim. Invasive Gynecol, 2019：23, S94.
6	Chao X, Liu Y, Ji M, et al. Malignant risk of pelvic mass after hysterectomy for adenomyosis or endometriosis[J]. Medicine (Baltimore), 2020, 99(15)：e19712.
7	Qian J, Gracious K, Chen L, et al. Primary vaginal cancer after hysterectomy for benign conditions: a systematic review of the literature[J]. Front Oncol, 2024, 14：1334778.
8	Yang H, Gu JJ, Qi Y, et al. Endometrioid adenocarcinoma of the rectovaginal septum with invasion of the rectum: a case report and review of literature[J]. World J Surg Oncol, 2019, 17(1)：206.
9	Balasubramaniam D, Duraisamy KY, Chinnusamy P, et al. Feasibility of laparoscopic hysterectomy in stage IV pelvic endometriosis: our technique and outcomes[J]. J Midlife Health, 2020, 11(1)：27-33.
10	Uccella S, Marconi N, Casarin J, et al. Impact of endometriosis on surgical outcomes and complications of total laparoscopic hysterectomy[J]. Arch Gynecol Obstet, 2016, 294(4)：771-778.
11	Yamamoto M, Yoshida H. Feasibility and safety of total laparoscopic retrograde hysterectomy in a large uterus with obliterated Cul-de-sac due to severe endometriosis[J]. Eur J Obstet Gynecol Reprod Biol, 2021, 258：43-47.
12	Xu G, Lovell DY, Guan X. Robot-assisted vaginal natural orifice transluminal endoscopic surgery (RvNOTES) with total hysterectomy for management of stage IV endometriosis with/without complete cul-de-sac obliteration: 23-case pilot feasibility study[J]. J Minim Invasive Gynecol, 2024, 31(6)：496-503.
13	Melnyk A, Rindos NB, El Khoudary SR, et al. Comparison of laparoscopic hysterectomy in patients with endometriosis with and without an obliterated Cul-de-sac[J]. J Minim Invasive Gynecol, 2020, 27(4)：892-900.
14	Sonkusare A, Dixit P. Comparative analysis of total laparoscopic hysterectomy versus non-descent vaginal hysterectomy for benign uterine pathologies in women: a systematic review[J]. Cureus, 2024, 16(6)：e62846.
15	黄荷凤，邓雅珑，顾航超，等．腹腔镜下全子宫切除术并发泌尿道损伤的相关因素分析[J]．中国计划生育和妇产科，2020，12(2)：72-75.
16	Gupta S, Maghsoudlou P, Ajao M, et al. Very low rates of ureteral injury in laparoscopic hysterectomy performed by fellowship-trained minimally invasive gynecologic surgeons[J]. J Minim Invasive Gynecol, 2022, 29(9)：1099-1103.
17	Senapati S, Alsaden IM, Schroer M, et al. Obliterated posterior Cul-de-sac laparoscopic surgical simulation[J]. Obstet Gynecol, 2021, 138(1)：95-99.
18	Isik-Akbay EF, Harmanli OH, Panganamamula UR, et al. Hysterectomy in obese women: a comparison of abdominal and vaginal routes[J]. Obstet Gynecol, 2004, 104(4)：710-714.
19	Hou Z, Liu T, Li X, et al. Risk factors for postoperative ileus in hysterectomy: A systematic review and meta-analysis[J]. PLoS One, 2024, 19(8)：e0308175.
20	Chikazawa K, Imai K, Ichi N, et al. Easy and standardized technique for the dissection of severe pouch of douglas obliteration mainly by blunt dissection in total laparoscopic hysterectomy for deep infiltrating endometriosis[J]. Gynecol Minim Invasive Ther, 2023, 12(3)：179-180.
21	彭超，周应芳，张蕾．直肠阴道隔子宫内膜异位症腹腔镜手术技巧[J/OL]．中华腔镜外科杂志(电子版)，2024，17(5)：257-261.

	完全封闭组(n＝54)	未完全封闭组(n＝61)	t/χ²值	P值
年龄(±s，岁)	45.61±3.96	47.41±3.81	2.479^a	0.015^a
BMI(±s，kg/m²)	24.68±4.21	23.92±3.20	－1.099^a	0.274
复发[例(%)]	16(29.6)	6(9.8)	7.254^b	0.007^b
术前用药史[例(%)]	34(63.0)	47(77.0)	2.729^b	0.099
盆腔手术史[例(%)]	37(68.5)	38(62.3)	0.489^b	0.484
痛经史[例(%)]	46(85.2)	38(62.3)	7.622^b	0.006^b

	完全封闭组(n＝54)	未完全封闭组(n＝61)	t/χ²值	P值
年龄(±s，岁)	45.61±3.96	47.41±3.81	2.479^a	0.015^a
BMI(±s，kg/m²)	24.68±4.21	23.92±3.20	－1.099^a	0.274
复发[例(%)]	16(29.6)	6(9.8)	7.254^b	0.007^b
术前用药史[例(%)]	34(63.0)	47(77.0)	2.729^b	0.099
盆腔手术史[例(%)]	37(68.5)	38(62.3)	0.489^b	0.484
痛经史[例(%)]	46(85.2)	38(62.3)	7.622^b	0.006^b

	完全封闭组(n＝54)	未完全封闭组(n＝61)	χ²值	P值
腹膜EM[例(%)]	22(40.7)	45(73.8)	12.850	<0.001^**
卵巢EM[例(%)]	35(64.8)	18(29.5)	14.370	<0.001^a
骶韧带EM [例(%)]	42(77.8)	26(42.6)	14.648	<0.001^a
直肠阴道隔EM [例(%)]	46(85.2)	8(13.1)	59.733	<0.001^a
输尿管EM[例(%)]	8(14.8)	5(8.2)	1.251	0.263

	完全封闭组(n＝54)	未完全封闭组(n＝61)	χ²值	P值
腹膜EM[例(%)]	22(40.7)	45(73.8)	12.850	<0.001^**
卵巢EM[例(%)]	35(64.8)	18(29.5)	14.370	<0.001^a
骶韧带EM [例(%)]	42(77.8)	26(42.6)	14.648	<0.001^a
直肠阴道隔EM [例(%)]	46(85.2)	8(13.1)	59.733	<0.001^a
输尿管EM[例(%)]	8(14.8)	5(8.2)	1.251	0.263

	完全封闭组(n＝54)	未完全封闭组(n＝61)	Z/χ²值	P值
手术时间[M(P₂₅，P₇₅)，min]	147.00(114.75，176.75)	95.00(81.00，117.00)	－5.997	<0.001
术中出血[M(P₂₅，P₇₅)，ml]	50.00(20.00，100.00)	20.00(10.00，20.00)	－4.753	<0.001
输尿管游离[例(%)]	44(81.5)	15(24.6)	37.108	<0.001
围术期输尿管支架置入[例(%)]	3(5.6)	2(3.3)	－	0.664

Please choose a citation manager

Content to export