Nerve-Sparing Surgery for Parametrial Endometriosis

Surgical excision of parametrial endometriosis carries a risk of postoperative bladder, bowel, or sexual dysfunction due to pelvic autonomic nerve injury. Nerve-sparing surgery reduces these adverse effects and improves quality of life. However, experience remains limited, and further studies are needed to evaluate its feasibility and functional outcomes.

This retrospective case series included 29 patients with advanced parametrial endometriosis who underwent nerve-sparing surgery. The primary objective was to evaluate postoperative urinary and defecatory function; the secondary objective was to assess surgical complications.

Among 29 patients, 7 (24.1%) had stage III disease and 22 (75.9%) had stage IV disease per American Association of Gynecologic Laparoscopists (AAGL) criteria. Surgical approaches included laparoscopy in 17 (58.6%), robotic surgery in 10 (34.5%), and conversion to laparotomy in 2 (6.9%). All cases involved nerve-sparing radical excision of endometriosis. Additional procedures included ureterolysis in all 29 patients (100%), enterolysis in 19 (65.5%), bowel shaving in 9 (31.0%), discoid resection in 5 (17.2%), segmental resection in 3 (10.3%), diaphragm excision in 2 (6.9%), partial cystectomy in 2 (6.9%), appendectomy in 3 (10.3%), and abdominal wall excision in 1 (3.4%). Operative time was 284 ± 99.3 min; estimated blood loss was 201 ± 216 mL. There was 1 intraoperative and 3 postoperative complications. One patient reported incomplete voiding with a postvoid residual under 100 mL, resolving within 1 week. Another reported increased bowel frequency that resolved within 1 month.

Nerve-sparing is critical in the surgical treatment of parametrial endometriosis to minimize compromise of urinary and defecatory function.