Cystoscopy-assisted laparoscopy for bladder endometriosis: modified light-to-light technique for bladder preservation

Area of Science:

• Gynecologic Surgery
• Urologic Endoscopy
• Minimally Invasive Procedures

Background:

• Endometriosis affects 15% of reproductive-age women, with 1-2% involving the urinary tract.
• The bladder is the most common urinary organ affected (85% of cases).
• Partial cystectomy, particularly videolaparoscopic, is the most effective treatment for bladder endometriosis.

Purpose of the Study:

• To identify and delineate intravesical endometriosis lesions.
• To determine precise resection margins.
• To achieve optimal bladder reconstruction and preservation.

Main Methods:

• A modified light-to-light technique using simultaneous cystoscopy during laparoscopic partial cystectomy.
• 25 consecutive patients (ages 27-47) with deep endometriosis and total bladder involvement.
• Average lesion size: 2.75cm; average surgical time: 137.7 minutes.

Main Results:

• Postoperative follow-up averaged 32.4 months (12-78 months).
• Clinical evaluations and cystoscopies were performed every six months.
• No endometriosis recurrence was observed during the follow-up period.

Conclusions:

• Cystoscopy-assisted partial laparoscopic cystectomy with the modified light-to-light technique accurately identifies lesion boundaries.
• This method enables safe bladder reconstruction, maximizing organ preservation.
• The technique is effective for treating intra- and extravesical endometriosis.