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Related Experiment Video

Updated: Feb 28, 2026

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The Optimal Surgical Approach for Deep Infiltrating Endometriosis Involving Pelvic Nerves (type 1 and 2).

Nicolas Samartzis1, Dimitrios Rafail Kalaitzopoulos1, Laurin Burla1

  • 1Department of Gynecology and Obstetrics, Cantonal Hospital of Schaffhausen, Switzerland (Drs. Samartzis, Kalaitzopoulos, Burla); IFEMEndo, Clinique Tivoli-Ducos, Bordeaux, France (Dr. Roman); IFEMEndo-Middle East Clinic, Burjeel Medical City, Abu Dhabi, UAE, (Dr. Roman).

Journal of Minimally Invasive Gynecology
|February 26, 2026
PubMed
Summary

Deep infiltrating endometriosis in the parametrium presents two distinct types based on location and involved pelvic structures. A systematic surgical approach is crucial for safe excision and minimizing nerve injury.

Keywords:
Endometriosislumbosacral plexusrobotic surgerysciatic nerve

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Area of Science:

  • Gynecologic Surgery
  • Minimally Invasive Surgery
  • Pelvic Anatomy

Background:

  • Deep infiltrating endometriosis (DIE) of the parametrium poses significant surgical challenges due to its proximity to vital pelvic nerves.
  • Accurate anatomical knowledge and strategic surgical planning are essential for successful excision.
  • Current classifications may not fully capture the nuances of DIE in this region.

Purpose of the Study:

  • To propose a new classification for deep infiltrating endometriosis of the parametrium based on nodule location and involved pelvic structures.
  • To demonstrate a standardized and reproducible surgical technique for each identified type of DIE.
  • To enhance surgical outcomes and minimize complications during parametrial endometriosis excision.

Main Methods:

  • Surgical procedures were performed using the DaVinci Xi™ robotic system.
  • A novel classification system distinguishing between medial (Type 1) and lateral (Type 2) parametrial nodules was developed.
  • Detailed surgical steps, including anatomical dissections and nerve preservation strategies, were illustrated.

Main Results:

  • Type 1 nodules are located medially near the uterosacral ligaments, involving structures like the ureter, rectum, and sacral roots.
  • Type 2 lesions are situated laterally on the pelvic sidewall, potentially involving the obturator nerve, lumbosacral trunk, and sciatic nerve.
  • The proposed classification facilitates tailored surgical approaches for each nodule type.

Conclusions:

  • Deep infiltrating endometriosis of the parametrium can be categorized into two distinct types based on anatomical involvement (sacral root vs. lumbosacral/sciatic nerve).
  • A systematic, type-specific surgical strategy is vital for safe and effective excision.
  • This classification and approach aid in reducing the risk of inadvertent injury to critical pelvic structures.