Index

A surgical technique in , Antibiotics, 85 176-186 intraoperative, in cul-de-sac endome• Abortion, spontaneous, in periadnexal, with aspiration of endo• triosis , 107 -108 patients, 52, 63, 246 metriomas, 100 See also specific medications Absorbable surgical membranes, for postoperative, in laparoscopic sur• Antibodies, antiendometrial, 53 minimizing postoperative adhe• gery, 93 assay for, 64 sion formation, 194 postsurgical, and infertility or recur• and embryo implantation, 246- Abuse, sexual or physical, and chronic rence of pain, 164 247 pain, 270-271 preventing, in surgery, 78, 193-199 See also Immune system Acosta's classification, pelvic endometri• between the small bowel and abdomi• Antidepressants osis, 29, 29t nal wall, 215 for chronic pain, 271-272 Acupuncture, 232 Adnexa heterocyclic, for pain, 271-272 Adenocarcinoma malignant lesions of, differentiating Antigens. See CA-125 antigen; Immune bowel, colonoscopy to rule out, 73, from endometriomas, 99 system 262-263 preservation of, in hysterectomy, Antihistamines for minimizing postoper• endometrioid, 102 175 ative formation, 196 Adenomyoma, 9,16-17,77 Adnexectomy, 175 Appendix, endometriosis of, 128, 139- localization of, lOf Affective distress, and chronic pain, 140 Adenomyomata versus leiomyomata, 258 270-271 Artery, inferior epigastric, management Adenomyosis, 257-264 Age of from, 212 changes in B-cell and T-cell activity in, and cumulative pregnancy rates, for Aspiration, of endometriomas, versus re• 53 hMG/IUI treated patients, 251 moval of the cyst wall, 100 postsurgical, and infertility or recur• and evolution of endometriotic le• Autoimmune phenomena rence of pain, 164 sions, 14, 33-34 associated with endometriosis, 247 subserosal, 257 American Association of Gynecologic autoantibodies associated with adeno• Adhesiolysis, 87-92 Laparoscopists (AAGL), 207-220 myosis, 262 anterior ovarian, 89-90 American College of Obstetricians and laparoscopic, 195-197 Gynecologists (ACOG), 108 B and treatment of endometriosis, American Fertility Society (AFS), 108 93 classification scheme, 30-33 Beecham's classification, 28, 28t Adhesions revised, 32, 64 Bias, detection, 5 formation of, 242 Amitriptyline (Elavil), 272 Biofeedback, for chronic pain, 272 in endometriosis, 40 Analgesic therapy, time-contingent, 232 Biopsy, 70 pelvic Anatomy, of pain, 37-38 myometrial, for diagnosing adeno• danazol therapy to reduce the risk Anesthesia, complications of, in laparos• myosis, 260, 263 of,242-243 copy,212 Bladder and infertility, 62 Anovulation, associated with endometri• endometriosis of, 155-156 and pregnancy rate, 29 osis, 50 surgical management of, 73

289 290 Index

Bladder (Continued) Central models of pain, 268 electrosurgical excision of endometrio• injury to, in laparoscopic surgery, Cerebral endometriosis, 132 sis, 111 213-214 Chromotubations, 64 endometriosis of, 105-114, 143 postoperative complications involv- Classification schemes, 27-35 obliteration of, 112-113 ing, 219 Clinical findings, in adenomyosis, 257- injuries during surgery for, 217 Bladder flap, developing, 175, 176 258 Culdotomy Bladder pillars, transection of, 179, 183f Clinical presentation, of endometriosis, with cuff closure, 179, 183f Bleeding 61-63 posterior, 184f emergency laparotomy to control, 213 Clinical studies Curtis-Fitz-Hugh syndrome, 63 as an indication of bowel trauma, 216 case-control, 4 Cutaneous endometriosis, 132 postoperative, 218 uncontrolled, 4 Cutting current, electrosurgical settings, 111 Bowel Clomiphene citrate (CC), for treating en• Cyclooxygenase pathway involvement in endometriosis, 72-73 dometriosis-associated infertility, eicosanoid products of, 41 lysis of adhesions, 138-139 250 role of, in ovulation, 48 resection of, 143-149, 186 Coagulation Cyst in cul-de-sac endometriosis, 113 with a CO2 laser, 88 endometrial, 17 after hysterectomy, 176 for superficial endometriosis, 78 endometrial ovarian, 9 possibility of, in tertiary surgery, 71 Coelomic metaplasia pathogenesis of, 14-17 for postoperatively observed injury, resulting in endometriosis in men, Cystectomy 217 132-133 bladder, 155-156 to repair intraoperative injury, 216 theory of, 127 ovarian, 90, 100-102 sites of endometriosis in, 128 Cohen's classification, 30 Cystoscopy, for urinary tract endometri• Bowel preparation, 138 Colon osis evaluation, 129 in adhesion lysis, 197 anterior wall of, resection of severe en• Cytolytic lymphocytes (CL), 54 in cul-de-sac endometriosis, 107-108 dometriosis, 145, 147 in extrapelvic endometriosis, 81, 129 pseudomass in, differentiating from D prior to , 210 ovarian endometriosis, 95 Breakthrough bleeding, with progesto• Colony-forming unit-granulocyte• Danazoltherapy, 70, 164,232-234 gen medication, 236 macrophage (CFU-GM) cells, 48- for adenomyosis, 262 Bromocriptine, effect on development of 50 and androgenic side effects, 232 adenomyosis, animal experi• Colostomy, diverting, in repair of large for bladder endometriosis, 151 ments, 261-262 bowel injury, 218 and cytoxicity of peritoneal fluid in en• Buttram's classification, expanded, 30, Complement system, 53 dometriosis patients, 54 30t Complications FDA approval of, 77 of laparoscopy and fecundity of donor insemination c in bowel endometriosis, 148-149 patients, 46 in bowel repair in cul-de-sac sur• and pregnancy rate, in endometriosis CA-125 antigen gery, 113 patients, 50, 204, 248 in endometriosis, 64 in hysterectomy, 186-187 preoperative, and risk of hemorrhage, levels of preventing and managing, 207- 99-100 to differentiate endometriotic cysts 220 in recurrence, 190 from, 98 postoperative, 218-220 and resolution of obstruction, 46 to identify adenomyosis, 260-261 of presacral neurectomy, 119, 120 and risk of recurrence after laparos- to identify ovarian neoplasia, 231 Computed tomography (CT), for evalu• copic surgery, 162-164 , endometrial, and adenomyosis, ating adnexal masses, 99 study of, 242-243 262-263 Connective tissue, in subovarian adhe• Deep endometriosis, 15-16 Carcinoma, differentiation from atypi• sions, 19 and pain, 34, 40 cal endometriosis, 128 Contraindications, to operative laparos• in the peritoneum and soft tissue, 71 Cardiac disease, contraindication to la• copy, 209-212. See also Compli• Deep tissue techniques, 71 paroscopy in, 209 cations Denervation, combination with conser• Cardinal , dissection of, in hys• vative surgery, 164 terectomy, 179, 182f chocolate cysts, 96-97 Depression Cefoxitin, prophylactic, before bowel hemorrhagic, differentiating from and chronic pain, 270-271 surgery, 138 ovarian endometriosis, 95 with GnRH-a therapy, 235 Cell-mediated immunity, 233, 276-277 Corticosteroid-binding globulin (CBG), Dermoid cyst, differentiating from ovar• mechanism of, 53-54 displacement of progesterone and ian endometriosis, 95 Cellular changes, B-cell and T-cell activ• cortisol by danazol, 233 Dextran 70 (Hyskon), for minimizing ity in endometriosis, 53 Costs, laparoscopy versus laparotomy, postoperative adhesion forma• Center for Special Pelvic Surgery 204 tion, 194 (CSPS), analysis of laparoscopic Credentialing, 224-225 Diagnosis, 63-64 complications at, 207 Cul-de-sac of ovarian endometriosis, 98-100 Index 291

surgical, 78 clinical and pathologic evaluation, 96 Fiberoptics, for endoscopy, 82 See also Differential diagnosis differentiation from malignancy, 86 Fibrinolytic activity, suppression of, and Diaphragmatic endometriosis, 130 randomized prospective study of pro- adhesion formation, 193 pulmonary endometriosis originating cedures, 164 Fibromyosis, 16-17 from, 131 surgery for, 71-72 Fibrosis Diathermy treatment, and progression staged,73-74 around deep infiltrating implants, 87 of Stage I endometriosis, 69 treating, 89-92 at extragenital endometriosis sites, 128 Diathesis-stress model of chronic pain, Endometriosis pain associated with, 40 268 defined, 229-230, 275-278, 288 Fimbrioplasty, 197 clinical implication of, 269 microscopic, 34 Foley catheter, to reduce risk of injury Differential diagnosis peritoneal, 10-11 to the bladder, 210 of adenomyosis, by MRI, 260 See also Deep endometriosis; particu• Follicle of intestinal endometriosis, 129 lar systems, e.g. Urinary tract en• abnormal dynamics, 51 of ovarian endometriosis, 95-102 dometriosis function of, and prostaglandins, 48 of pulmonary endometriosis, 131 Endometriosis Association Follicle-stimulating hormone (FSH), to See also Diagnosis on association of endometriosis with identify ovarian remnants, 190 Dioxin, and immune responses, 279 other health problems, 278 Forceps Distraction, and pain tolerance, 268 research registry of, 276 atraumatic Doxepin (Sinequan), 272 Endorphins, and pain management, 232 for laparoscopic adhesiolysis, 88 Dwell time, in electrosurgery, 109-110 Endoscopy, 77-78 atraumatic grasping, for ovarian endo• Dyschezia, and endometriosis, 62 for radical surgery, 81 metrioma excision, 90 Dysmenorrhea for rectal endometriosis, 81 bipolar, 88 in adenomyosis, 258 Enterotomy, 81 Frankenhauser's ganglia, 38 without endometriosis, LUNA for, during enterolysis, 197 118 Epidemiology, 3-6 G endometriotic lesions associated with, Equipment, laparoscopic, 110-114 17,39,276-277 Estrogen/progestin therapy, 70 Galactorrhea, association with endome• and pain, 38-39, 62, 232 Estrogen-progestogen therapy, 77 triosis, 50, 63 and prostaglandins, 48 Estrogen replacement therapy, and re- Gas embolism, managing, 211 , 62 currence of endometriosis, 169, Genitourinary tract in adenomyosis, 258 189. See also Hormone therapy endometriosis of, 151-157 endometriotic lesions associated with, Evaluation extraabdominal endometriosis in, 17 of chronic pain, with endometriosis, 130-131 and pain, 38-39, 189 269-271 postoperative complications involv• after hysterectomy, 180 ing, 219 E preoperative, 174 Gestagen therapy, effect on recurrence for ovarian endometriosis, 98- rate after surgery, 161 Ectopic pregnancy, differentiating from 100 Gestrinone, 236 ovarian endometriosis, 95 Excision versus coagulation or vaporiza- GIFT (gamete intrafallopian transfer), Edema, at extragenital endometriosis tion, 87, 108 252 sites, 128 Ex novo implants, after surgery, 159 Glands, endometrial, identified at bi• Eicosanoids, 47-48 Expectant management, 70 opsy, 19-21 Electrical injury Extraabdominal endometriosis, pain Glandular papule, 11-12 to the ascending colon, 218 with,62 Gonadotropin, serum levels, to identify to the small bowel, 215-217 Extragenital endometriosis, 127-133, ovarian remnants after surgery, Electrosurgery, 79 231 189-190 for cul-de-sac endometriosis, 109-110, Extrapelvic endometriosis, 34, 81-82, Gonadotropin-releasing hormone 111 231 (GnRH), treatment for adeno• equipment for, complications associ• and recurrence, 190-191 myosis, 263 ated with, 212-213 Gonadotropin-releasing hormone ago• trends in technology, 82 F nist (GnRH-a), 77,190,234-235 See also Surgery/surgical therapy biopsy after therapy with, 22-23 Embryo gamete toxicity, of peritoneal Falloposcopy, transcervical, intratubal effect of fluid,47 adhesions identified by, 46 on the pelvic environment, 243-244 Endocrine abnormalities, 50-52 Familial occurrence, of endometriosis, on peritoneal fluid cytotoxicity in Endometriomas 98-100 endometriosis patients, 54 and anovulation, 46 Fecundity, and endometriosis, in artifi• for intestinal endometriosis, 129 aspiration of, versus removal of the cial insemination, 46 preoperative use of, 99-100, 129, 130 cyst wall, 100 Fertility, and immune responses in for pulmonary endometriosis, 131 classification of, 96-98 women with moderate endometri• three-dimensional appearance of le- versus ovarian neoplasia, 231 osis,55 sions after, 23-24 292 Index

Gore-Tex, for reduction of postopera• for adenomyosis, 263 Infection, postoperative, 219 tive adhesions, 195 avoiding, with deep infiltrating perito- Infertility Goserelin (Zoladex), 235 neal implants, 88-89 association with superficial implants, 117 for endometriosis, 5 and endometriosis, 62, 202-204, 230- H overall rate of, trend, 6 231,277 recurrent endometriosis after, 189-191 pathogenesis of, in endometriosis, 45-55 Hemangiomas, differentiating from en• reoperation for endometriosis after, and postoperative adhesions, 193 dometriomas, 86 161-162 and prevalence of endometriosis, 3 Hematogenous spread, 127-128 supracervical, 173 and recurrent endometriosis, 165-169 in parenchymal endometriosis, 131 total abdominal, 81 and superficial implants, 34 Hematuria, in urinary tract endometrio• vaginal, contraindications, 173 treatment of sis, 129 vaginal portion of, 176 in endometriosis, 245-252 Hemoperitoneum, 130 Hysterosalpingography (HSG), for aden• surgical, 78-80 Hemoptysis, in parenchymal endometri• omyosis diagnosis, 260 See also Pregnancy osis, 131 Hysteroscopy, endometrial ablation for Inflammatory cells, peritoneal fluid Hemostasis, 87 adenomyosis, 263 in endometriosis, 40 in endometrioma excision, 90 and fertility, 247 Hemothorax, in pleural endometriosis, I prostaglandins produced by, 41 131 Inflammatory response Hernia, incision, as a postoperative com• Ileostomy, diverting, in repair of electri• local factors in, 52-54 plication, 219-220 cal injury to the ascending colon, in moderate to severe endometriosis, Histogenesis, of peritoneal endometrio• 218 55 sis, 19-24 Iliac vessels, injury to, laparotomy to Inflammatory tubo-ovarian complex, Histology correct, 212 differentiating from ovarian en• of chocolate cysts, 95-96 Imaging studies dometriosis, 95 confirmation of endometriosis, by le• computed tomography (CT), 99 Informed consent, 174 sion type, 64 for diagnosing endometriosis, 64 Infundibulopelvic ligaments, 176 Hormones magnetic resonance imaging (MRI), electrodesiccation of, 175, 181f hypothalamo-pituitary, effects of da• 99,259-260 Inguinal endometriosis, 132 nazol,233 preoperative, in cul-de-sac endometri• Interleukin-l (IL-l) independence of, endometrial im• osis, 106-107 and fertility, 247 plants, 22 Immune system in peritoneal fluid of women with en• response to, and type of endometrio• abnormalities of, 52-54 dometriosis, 47, 49 sis, 16 factors in adenomyosis, 262 Interobserver variability, in classifica• See also Steroids and fertility, 246-247 tion with the AFS-r scheme, 33 Hormone therapy humoral, 52-53 Intestine effect of, 13 suppression of, and development of endometriosis of, 128-129, 137-157 in ovarian endometriosis, 95 endometriosis, 230, 233 and recurrence, 191 after first staged surgery, 73-74 See also Antibodies, antiendometrial; obstruction of for infertility, 248-252 Autoimmune phenomena; Cell• contraindication to laparoscopy in, postoperative, 249 mediated immunity 209 See also Estrogen entries Immunoglobulins, IgG and IgA, in the immediate intervention in, 81 Huffman's classification, 28t of endometriosis Intraabdominal extragenital endometrio• Human menopausal gonadotropin patients, 52-53. See also Antibod• sis, 130 (hMG), for treating endometrio- ies, antiendometrial Intraperitoneal dissemination, 128 sis-associated infertility, 250-251 Immunomodulators, future of, in man• Intrauterine insemination (lUI), for Hydrodissection, 142, 197 aging endometriosis, 236 treating endometriosis-associated in high-risk areas, 152 Implants, 275-276 infertility, 250 in hysterectomy, 174 diagnosing with magnetic resonance Intravenous pyelogram for laparoscopic adhesiolysis, 88, 139 imaging, 99 to evaluate urinary tract endometrio• protecting the ureter with, 214-215 ureteral, 73 sis, 129 in removal of type lIB endometrio- Incidence, of newly diagnosed cases, 5 evaluating ureteral injury with, 215 mas, 100 Indications, for adjunctive procedures in In vitro fertilization (lVF), 252 Hyperplasia, atypical, with endometrio• conservative surgery, 117 data indicating ovulatory disorders, sis, 153 Indomethacin 62-63 Hyperprolactinemia, 50-51 blockage of -induced luteal re• and infertility, 63 gression, 48 K Hypnosis, for chronic pain, 272 blockage of peritoneal fluid effect on Hypoestrogenism, induced by GnRH-a, embryo growth, 47 Kidney, direct involvement in endometri• 234 reversal of peritoneal fluid cytotoxic• osis, 130, 155 Hysterectomy, 173-187 ity,54 Kistner's classification, 29-30, 30t Index 293

L for vaporization of peritoneal im• for diagnosis of adenomyosis, 259- plants, 88 260 Laparoscopically assisted vaginal hyster• for cul-de-sac endometriosis treat• for diagnosis of endometriosis and en• ectomy (LAVH), 173 ment, 109 dometriomas, 99 Laparoscopic uterine nerve ablation for dissection, types of, 79-80 Magnification, in adhesiolysis, 88 (LUNA), for , 80, 118, neodymium:YAG,88 Malignancy 165 for excision of nerve bundles, 120 with advanced endometriosis, 28-29 Laparoscopy Learning transformation to, in endometriomas, conservative of motor skills for laparoscopy, 223 102 pregnancy after, 79t and pain perception, 268 Mechanical factors, contributing to in• recurrence after, 160t Learning curves fertility in endometriosis, 245-246 diagnostic, 29, 63-64, 78, 79, 99, for conventional and endoscopic sur• Meckel's diverticulum, endometriosis in, 173 gery, 224 128 and physician expertise, 208 forlaparoscopy, 208-209 Medical therapy, 77 hysterectomy using, 81 Leiomyomata adjunctive, in cul-de-sac endometrio• versus laparotomy, 100,201-205 versus adenomyomata, 258 sis, 108 for cul-de-sac endometriosis, 108- and adenomyosis to attempt conception, in recurrent en• 109 association with, 259 dometriosis, 165 repeat conservative surgery, 164 differentiating from, 260 combination of, with surgical treat• laser technique, 174-176 Leiomyomatosis peritonealis dissemi- ment, 241-244 near-contact, to identify lesions, 70 nata, 11 duration of, 244 operative, issues in, 223-226 Lesions in endometriosis, 229-244 for pelvic pain, 80 advanced active, 13 postoperative suppression, 244 repeated,73-74 appearance of, 19-21, 2lf preoperative suppression, 242-243 therapeutic, 70, 71, 78-80 early active, peritoneal, 11-13, 12f indications for, 70 in colorectal endometriosis, 137 healed, 13-14 before laser treatment of endometrio• pain relief in, 202 subtle endometriotic, 19-21 mas, 91 pregnancy rate following, 203 documentation of, 33 for ovarian remnant syndrome, 190 recurrence rate after, 162-164 Leucine aminopeptidase, indicator for for ovarian suppression, preoperative, for type IIA endometriomas, 100 activation of macrophages, 49 99-100 See also Surgery/Surgical therapy Leukotrienes recurrence of endometriosis after, 164 Laparotomy, 71 B4 (LTB4), 41 See also Danazol therapy; Hormone conservative, pregnancy rate after, 79t involvement in anaphylactic immune therapy; specific medications exploratory, in tertiary surgery, 71 response, 48 Meditation, for chronic pain, 272 versus laparoscopy, 100 Leuprolide acetate (Lupron), 234-235 Medroxyprogesterone acetate (Depo- in repeat conservative surgery, 164 Lipoxygenase pathway, 41 Provera, MPA), 236 outpatient, 287-288 Liver, endometriosis of, 130 Men, endometriosis in, 132-133 palpable lesions identified at, 73-74 Luteal phase defect (LPD), 51, 62-63, Menorrhagia, in adenomyosis, 258 possibility of, in extrapelvic endome- 62t Menstrual abnormalities, abnormal triosis, 81 and infertility in endometriosis, 246 bleeding, 62 See also Surgery/surgical therapy Luteinized unruptured follicle (LUF) Metrorrhagia, in adenomyosis, 258 Large bowel syndrome, 51-52,62,246 Microsurgery injury to, in laparoscopic surgery, Lymphatic dissemination, 127 adhesions after, 193 217-218 Lymphocytes advantages of, 203 postoperative complications involv• peripheral, changes in endometriosis, for ovarian endometrioma, 78 ing, 218-219 233 Migraine headaches, and GnRH-a ther• Laser T- and B-, changes in peritoneal fluid apy,235 CO2 of endometriosis patients, 54 Miscarriage, in endometriosis-associated for adhesion lysis, 139 Lysis pregnancy, 250 attached to a laparoscope, 88 of bowel adhesions, 138-139 Mitchell and Farber's classification, 29t avoiding carbonization in use of, susceptibility of adhesions to, 30 Monthly fecundity rate (MFR), for eval• 87 See also Adhesiolysis uating conservative surgery for for dissection, 71, 73 endometriosis, 203 for dissection of adhesions, 197 M Morphology with hydrodissection, 152 of biopsied peritoneal endometriosis, for laparoscopic adhesiolysis, 88 McBurney incision, 151 21t and postoperative adhesion forma- Macrophages of stromal vascularization, 22t tion, 193-194 activation of, 49 Mortality, in laparoscopic procedures, 220 for treatment of superficial ovarian and fertility, 247 Mullerian system endometriotic lesions, 91 peritoneal,48-50 cells as a source of endometriosis, 127 for uterine nerve ablation, 118 Magnetic resonance imaging (MRI) secondary, metaplastic potentiality, 11 294 Index

Muscle relaxation, progressive, for containing an endometrial cyst, 9 Paracrines, secretion by endometriosis chronic pain, 272 cysts of, considering in preoperative implants, 201-202 Musculoskeletal endometriosis, 132 evaluation for laparoscopy, 210 Parametrial endometriosis, 165 Myeloperoxidase, staining for, to con• enlarged, 63 Pathogenesis, 9-17 firm activation of macrophages, hematomas of, subgroups of, 27 of adenomyosis, 261-262 49 preservation of function, in laparos- of infertility, in endometriosis, 45-55 Myomatous , considering in preop• copic dissection of endometrio• of pain, 39-41 erative evaluation for laparos• mas, 92 of peritoneal endometriosis, 10-17 copy,210 subgroups of hematomas, 27 Pathology, history of surgical, 9-10 surgery for endometriomas, 71-72 Pathophysiology, of extragenital endo• N treatment of endometriosis of, 95- metriosis, 127-128 102 Patient management, perioperative, 114 Nafarelin acetate (Synarel), 234- Ovulation, disordered, and endometrio• Pelvic inflammation 235 sis, 62-63 antiendometric antibodies after, 247 Narcotics, for chronic pain, 270 Oxford Family Planning Association postsurgical, and infertility or recur• Nasogastric tube, for prevention of in• study, 5 rence of pain, 164 jury in establishing a pneumoperi• Oxidized regenerated cellulose (lnter• Pelvic inflammatory disease (PID) toneum, 210-211 ceed), for minimizing postopera• adhesions between diaphragm and National Center for Health Statistics tive adhesion formation, 194 liver in, 63 (NCHS),5-6 Oxygen products, reactive, associated antiendometrial antibodies found in, Natural history of endometriosis, 159 with peritoneal macrophages 53 Natural killer (NK) cells, 52, 233 from endometriosis patients, 49 Pelvis in peripheral lymphocytes of endome- extensive endometriosis of, surgical triosis patients, 54 p technique for, 176-186 Nephrectomy, 130 mechanical factors in infertility, 46-52 Nerve blocks, for pain management, 232 Pain supportive structures, nodular endo• Neurologic syndromes, postoperative, chronic, team planning of treatment, metriosis involving, 16-17 219 271-272 Pentoxifylline, evaluation of, for man• Neurotomy versus neurectomy, for deep chronic pelvic, 39 agement of endometriosis, 236, midline pelvic pain, 121 psychological aspects of, 267-272 247 Nodular endometriosis, 17 correlation with classification, 34, 232 Perforation, bowel, testing for, 142 pathogenesis of, 16-17 correlation with histopathologic stage Peritoneal endometriosis, 9-10 Nonsteroidal antiinflammatory drugs of endometriosis, 28 histogenesis of, 19-24 (NSAIDs), for pain with endome• with deep infiltrating endometriotic histology of, 21-22 triosis, 70 implants, 88-89 implants, 87 Norethindrone, 236 in endometriosis, 62, 201-202, 275- biopsy of, 86 Norethynodrel, therapy with, 28 276 deep infiltrating, 88-89 Norgestrel, with ethinyl estradiol, for in- in fibrotic endometriosis, and extent small,71 duced pseudopregnancy, 235-236 of excision, 70 treating, 88 as an indication for surgical treat• White, opacified, 19 o ment, 70 Peritoneal fluid, abnormalities in, and organic-type, association with classic fertility, 47-50 Observational error, in classification lesions, 39-40 Peritoneum with the AFS-r scheme, 33 outcomes of laparoscopic presacral deep resection of, 112 Obstruction, bowel, from advanced en• neurectomy, 120 superficial resection of, 111-112 dometriosis, 128-129 pelvic,230 Peritonitis, contraindication to laparos• Occlusion, endometriosis as an etiologic accompanied by infertility, 168-169 copyin,209 factor in, 46 endometriotic lesions associated Pfannenstiel incision, 122, 151 Operating room, preparation of, 85 with,17 Phosphatase, acid, indicator for activa• Oral contraceptives, for suppression of pathogenesis of, 37-41 tion of macrophages, 49 endometriosis, 70 and recurrence of endometriosis, Phospholipase A2, synthesis of eicosa• Osteoporosis, and GnRH-a therapy, 169, 189 noids controlled by, 48 235 surgery for, 80 Photodynamic therapy, development of, Outpatient procedures, physiology of, 37-38 82 for rectal and rectovaginal septum en• relief of, after surgery, 74 Physical examination, in suspected endo• dometriosis, 141 shoulder, in endometriosis of the dia• metriosis, 63 for laparotomy, 287-288 phragm, 63 Pigmentation, correlation with classifica• Ovarian fossa, diagnosis of endometrio• visceral, physiology of, 37-38 tion of endometriotic lesions, 33 sis of, 63 See also Referred pain Pillowing, in electrosurgery, 11 0 Ovarian remnant syndrome, 190 Pancreatic endometriosis, 130 Plexus , IOf Papular lesions, atypical, prostaglandin pelvic, 37-38 adhesions and fertility, 46 production by, 39-41 superior hypogastric, 118-119, 119f Index 295

Pneumo-omentum, complication of Ver• in adenomyosis, 259 Reperitonealization, of large denuded ar• res needle insertion, 211 and pelvic pain, 41 eas, in conservative surgery, 78 Pneumoperitoneum, complications in es• F2a, levels of, in endometriosis, 41 Reproductive techniques tablishing, 210-211 inhibition of synthesis of, and perito• assisted, 231 Pneumothorax, in pulmonary endome• neal fluid cytotoxicity, 54 success rate in recurrent endometrio• triosis, 131 production of sis, 165 Population studies and pain, 41, 232 See also Intrauterine insemination of endometriosis and fertility, 45 by red hemorrhagic lesions, 12 (lUI); In vitro fertilization (IVF) prevalence of endometriosis, 3 tubal dysfunction, 246 Retrograde menstruation, as a source of Positioning of patients, 110, 174 as regulators of cellular function, 47- endometriosis, 127 Postmenopausal endometriosis, 189 48 Retroperitoneal endometriosis, surgery Pouch of Douglas synthesis of, 40f for, 70 biopsy from, Ilf Prostaglandin synthetase inhibitors (Pg• Retroperitoneal space, 12lf implants in, and dyspareunia, 81 SIs), for dysmenorrhea, 232 Risk factors, for endometriosis, 61 involvement of Pseudocyst, ovarian, 9 Round , electrodessication of, deep endometriosis, 117 Pseudomembranous enterocolitis, from 178f at repeat operation, 164 bowel preparation, 107-108 Rubin's cannula, misplacement of, and Pregnancy Pseudomenopause, from danazol admin• bladder injury, 213 after conservative surgery for endome• istration, 232-234 triosis, 27-28, 31, 46, 74, 203 Pseudopregnancy, estrogen/progesto• s ectopic, differentiating from ovarian gen-induced, 235-236 endometriosis, 95 Psychological factors, in chronic pelvic Salpingitis isthmica nodosa (SIN), differ• rate of pain, 41, 267-272 entiating from adenomyosis, 257 cumulative, 203 Psychotherapy, for chronic pain, 272 Salpingo- cumulative, for hMG/IUI treated Pulmonary endometriosis, 131-132 for benign disease, 186 patients, 251 bilateral, 81 after danazol treatment, 233-234 R recurrent endometriosis after, 189- with medical management, 241-242 191 after reoperation, 165 Recovery time, laparoscopy versus lapa• Scars, surgical, endometriosis in, 130- and severity of disease, 203 rotomy, 204, 287-288 131 after surgery plus danazol treat- Rectosigmoid colon Sciatica, cyclic, 132 ment, 242-243 dissection from the uterus, 177-178f Sciatic nerve See also Infertility injury to, in laparoscopic surgery, endometriosis of, 132 Preoperative evaluation, 174 217f injury observed postoperatively, 219 Preoperative hormone therapy, 248-249 Rectovaginal septum Second-look laparoscopy, 91, 102 Preperitoneal insufflation, compromise endometriosis of, 16f, 81 identification of hematoma, 187 of cardiac function in, 211 involvement at repeat operation, 164- Secretory protein PPI4, 64 Presacral nerve trunk, 122f 165 Self-banked blood, 71, 73 Presacral neurectomy (PSN), 118-121 Rectum, dissection of, 89, 177f Semm's technique, 72 for pain, 80, 92, 202, 232 Recurrence, 159-169 Serum markers, for diagnosing endome• Prevalence of intestinal endometriosis, 129 triosis, 64 of adenomyosis, 258 after laparoscopic excision, 114 Sex hormone-binding globulin (SHBG), of endometriosis, 61 prevention of, 231 replacement testosterone and es• in women undergoing laparoscopy, rates of, 117 tradiol by danazol, 233 39 cumulative, 162 Shoulder pain, postoperative identifica• Prevention, of complications in laparos• Referred pain tion of, 219 copy,207-208 with adhesion formation, 40 Simulation, for surgical training, 224 Procedures, standardization of, for la• in diaphragmatic endometriosis, Small bowel, 149-151 paroscopy, 209-210 130 injury to, in laparoscopic surgery, Progestins See also Pain 215-217 for pulmonary endometriosis, 131 Regression Sociological mysteries, in endometriosis for therapy, 28 luteal, induction by estradiol, 48 evaluation, 280-282 Progestogens, pseudopregnancy induced spontaneous, 69-70 Somatic models of pain, 268 by,236 Rehabilitation, in treatment of chronic Somatization disorders, 281 Prolactin, role of, in genesis of adeno• pain, 272 Sonography, transvaginal color Dopp- myosis, 261-262 Renal function, loss of, in ureteral endo• ler, to diagnose endometriomas, Prostacycline (PGI2), 48 metriosis, 129 98-99 Prostaglandins Reoperation Sperm E2, and embryo toxicity, 47 rate of motility of, and endometriosis, 47 F, production of, and histology of en• after conservative surgery, 160-162 phagocytosis of, 49 dometriotic implants, 34 after preservation of ovarian tissue, Staging Fla, 6-keto (6-KF) 81 of endometriosis, 27-35 296 Index

Stereometry, of endometriotic implants, as a measure of eicosanoids, 48 and recurrence, 191 23-24,23t Totallaparoscopic hysterectomy (TLH), Uterine suspension Sterilization, prevalence of endometrio• 173, 179-180 Gilliam, 122-123 sis seen at the time of, 39, 45 Trendelenburg position, 85 laparoscopic, 124 Steroids for presacral neurectomy, 119 purpose of, 122 effect of, on macrophage stimulation, 49 risk to cardiac patients in, 209 Uterine vessels, management in hysterec• and the immune system, 279 Trends, in surgical treatment, 82 tomy, 175-176, 18H for minimizing postoperative adhesion Trimethoprim, following bladder sur• Uterosacral ligaments formation, 194 gery, 156 deep endometriosis involvement of, receptors for Trocar 117 in adenomyosis, 262 preventing injury during insertion of, dissection of, 175 in endometriosis, 190 211,217 excision of nodules, 89 sex, and development of adenomyosis, secondary, preventing injury during localization of endometriosis on, 262 insertion of, 212 165 See also Hormones Tubal dysfunction, in endometriosis, resection of, 112 Stroma, glands with, as a basis for classi• 246 with presacral neurectomy, 118 fication, 27 Tubal ligation Uterosacral nerve, ablation of, 202, Subtotal laparoscopic hysterectomy complications of, and physician exper• 232 (SLH), 173, 180, 185 tise, 208 damage to the ureter during, 92 Sulfamethoxazole, following bladder laparoscopic, prevalence of endometri• Uterovesical fold, deep endometriosis surgery, 156 osis identified at, 45 involvement of, 117 Superovulation, for treating endometrio• Tubal motility, prostaglandin role in, 48 Uterus sis-associated infertility, 250 Tumor necrosis factor (TNF), in perito• complications involving, in laparos• Surgery/surgical therapy, 70, 100,287- neal fluid of women with endome• copy, 213 288 triosis, 47, 49 enlargement of, in adenomyosis, 257- combination of, with medical therapy, Two-puncture technique, for diagnostic 258 241-244 laparoscopy, 63 conservative v development of, 77 u for infertility, 78 Vaginally assisted laparoscopic hysterec• pain relief after, 202 Ultrapulse laser, 139, 176 tomy (V ALH), 173 effect on conception rates, 247-248 Ultrasound Vaporization of endometriosis, rationale for, 69-74 for assessing pelvic and adnexal for ablation of the uterosacralliga• for endometriosis lying over the ure- masses, 64 ments, 118 ter, 73 serial, to follow follicular growth, 51 for bowel lesions and adhesions, 73, historic context, 77-82 transabdominal 141 for peritoneal implants, vaginal inci• for adenomyosis diagnosis, 259 of endometriotic implants, 79, 88 sion, 89 transabdominal versus transvaginal, for genitourinary implants, 153 and progression of endometriosis, 69 for endometrioma diagnosis, 98- for ovarian endometriomas, 90 radical 99 for superficial endometriosis, 78 historical place of, 77, 80-81 transvaginal, 160 for type I endometriomas, 100 laparoscopy for, 92 for diagnosis of adenomyosis, 259 Vascularization repeat, effect on conception rates, 249 for diagnosis of ovarian endometri• of peritoneal endometriotic foci, 22 See also Electrosurgery; Laparoscopy; osis, 98 stromal, and three-dimensional evalu• Laparotomy Umbilical endometriosis, 63, 132 ation, 24 Symptoms Ureter Verres needle, preventing complications of adenomyosis, 258-259 endometriosis of, 129 with use of, 210-211 of endometriosis, 61 evaluation and dissection, 175 Vesicovaginal fistula, postoperative com• cul-de-sac, 105-108 with obstruction, 153 plication, 219 management of, 231-232 injury to, in laparoscopic surgery, Vesicular lesions (polyps), 11-12 214-215 Video monitoring in laparoscopy, 71, T possibility of resection, in tertiary sur• 110, 138, 202 gery, 71 setup for, 140f Thoracotomy, for pulmonary endometri• resection of, to repair injury, 215 osis, 131 Ureteroneocystostomy, 130, 154,215 w Thromboxane-A2, as an antagonist of Ureteroureterostomy, 130, 153-155,215, P0l2,48 219 Walthard islets Thromboxane-A2 and B2 Urinary tract endometriosis, 81-82, 129- differentiating from endometriomas, levels of, in pelvic pain, 41 131 86