Neurovascular Architecture of Deep Endometriosis and Postoperative Pain Outcomes after Butterfly Peritoneal Excision:
Kiper Aslan1, Erberk Cimer1, Selen Mutlu2
1Department of Obstetrics and Gynecology, School of Medicine (Aslan, Cimer, Kasapoglu and Uncu), Bursa Uludağ University, Bursa, Türkiye.
Study Objective:
To evaluate the neurovascular architecture of deep endometriosis using a standardized butterfly excision approach and to explore its association with postoperative pain outcomes.
Design:
Prospective exploratory pilot study.
Setting:
Tertiary referral center specializing in endometriosis surgery.
Patients:
Fifteen women with advanced posterior deep endometriosis undergoing laparoscopic excision.
Interventions:
Standardized butterfly peritoneal excision with systematic radial sampling from the central lesion to the peripheral peritoneum.
Measurements And Main Results:
Each specimen was divided into 15 segments (7 per side plus central lesion), yielding 240 total samples, including normal peritoneum. Nerve-fiber density showed a significant center-to-periphery decline (β = -0.3169, p <.001), corresponding on average to an estimated 27% reduction per segment, while capillary density demonstrated a parallel but less pronounced decrease (β = -0.100, p <.001), supporting a coordinated neurovascular gradient. No right-left difference was observed. In contrast, tissue pain mediators exhibited heterogeneous spatial distribution rather than a uniform center-dominant pattern. Among evaluated markers, only bradykinin was associated with nerve-fiber density (p <.001). In exploratory multivariable analyses, central nerve growth factor concentration showed an association with 6-month dysmenorrhea improvement (β = 0.012, p = .043), whereas morphometric nerve-fiber density did not. For chronic pelvic pain, baseline pain severity was the only variable associated with postoperative improvement (β = 0.777, p = .030). Clinically, postoperative reductions were observed across multiple pain domains, accompanied by improvements in physical and mental quality-of-life measures.
Conclusion:
Deep endometriosis demonstrated spatial neurovascular gradients with dissociation between structural innervation and inflammatory mediator distribution. Central neurotrophic activity showed an exploratory association with postoperative dysmenorrhea improvement, whereas morphometric nerve-fiber density did not. These findings support the feasibility and potential biological relevance of spatial neurovascular mapping in deep endometriosis and should be considered hypothesis-generating pending validation in larger studies.
Clinical Trial Number:
NCT06286371, https://clinicaltrials.gov/study/NCT06286371.
Date Of Registration:
22.02.2024.
