Current Endometriosis Classifications (rASRM, #Enzian, AAGL2021) and their Correlation with Operative Time

In the ongoing effort to identify or develop the optimal classification system for endometriosis, there is a paucity of data regarding the association between currently used classification systems and operative times. This study aims to evaluate the correlation between the rASRM, #Enzian, and AAGL2021 classifications and the duration of endometriosis surgery to determine the most accurate system for planning operating room resources.

This retrospective study included patients who underwent laparoscopic endometriosis surgery at Kepler University Hospital in 2021 and 2022. Surgeries were performed by experienced gynecologic surgeons, with endometriosis extent assessed using rASRM, #Enzian, and AAGL2021 classifications. Corrected operative time (total time minus fixed durations for common concomitant procedures) was used for analysis. Statistical analyses included descriptive statistics, Kendall's tau correlation, Spearman's correlation, Mann-Whitney U test, and generalized linear models.

Out of 248 patients with laparoscopic surgery for endometriosis, 139 met the in-/exclusion criteria. The median corrected operative time was 68.50 minutes. Significant positive correlations were found between surgery duration and stages in both rASRM and AAGL2021 classifications. The #Enzian classification also showed positive correlations with more complex analyses attributable to the classification structure. Operative times were longest in surgeries affecting compartments C3, A3, FI, and FU. Regression analysis identified several significant variables impacting surgery duration.

All three classification systems significantly impact operative time, with higher stages or specific coding correlating with longer durations. The AAGL2021 and #Enzian classifications can be used as preoperative diagnostic tools, with #Enzian offering more detailed coding. Future research should focus on prospective, multi-center studies to develop algorithms incorporating #Enzian codings for enhanced preoperative planning.