Nerve-sparing surgery in deep endometriosis: Has its time come?

Area of Science:

• Gynecology
• Surgical Innovation
• Neuroanatomy

Background:

• Nerve-sparing (NS) surgery for deep endometriosis (DE) emerged 20 years ago, integrating neuroanatomy and oncological surgical principles.
• The technique aims to preserve autonomic nerve fibers, minimize iatrogenic injury, and reduce postoperative visceral dysfunction while maintaining therapeutic efficacy.

Purpose of the Study:

• To review the evolution and outcomes of NS surgical techniques for DE over two decades.
• To assess the impact of NS surgery on postoperative voiding, bowel, and sexual functions.
• To evaluate the safety and effectiveness of NS surgery compared to conventional methods.

Main Methods:

• Literature review of anatomical details, dissection techniques, and functional outcomes of NS surgery for DE.
• Analysis of studies reporting on postoperative voiding dysfunction (POVD), bowel function, sexual function, pain relief, and fertility.
• Identification of predictive factors for POVD, such as preoperative dysfunction and parametrial infiltration.

Main Results:

• NS surgery is associated with reduced POVD, particularly when preoperative dysfunction is absent.
• Parametrial infiltration is a significant predictor of POVD.
• Benefits for bowel and sexual function are less consistent, but NS surgery may prevent new-onset dysfunctions.
• Perioperative complication rates, pain relief, and fertility outcomes are comparable to conventional surgery.

Conclusions:

• NS surgery represents an evolution in DE treatment, with demonstrated benefits in reducing POVD.
• The technique aims to preserve neurological function and minimize surgical trauma.
• While benefits for bowel and sexual function require further investigation, NS surgery offers comparable efficacy and safety to traditional approaches.