Correlation of Non-invasive Assessment of Deep Endometriosis Using the #ENZIAN Classification with Surgical Complexity – a Prospective Cohort Study
Endometriosis is a chronic disease which affects women in their reproductive age and is associated with several pain symptoms and impaired fertility. Depending on their location and biological behaviour, different forms can be differentiated such as superficial endometriosis, ovarian endometriosis, adenomyosis and the most severe form - deep infiltrating endometriosis (DE).
Transvaginal sonography (TVS) allows the assessment of endometriosis extent preoperatively (1). Due to the great diversity of endometriotic lesions, a systematic description system is required. Historically, the best known classification is the revised American Society for Reproductive Medicine (rASRM) score, which focuses on peritoneal disease and adhesions but does not take in account DE. In contrast, the #Enzian classification includes all phenotypes and has been shown to be applicable with non-invasive methods such as MRI and TVS (2, 3). Furthermore, there appears to be a significant correlation between disease extent and location of DE but also intensity of symptoms (4-6). As a consequence, the use of the #Enzian system allows appropriate counseling of patients, accurate planning of the surgery and multidisciplinary team involvement, if required (7).
Surgical treatment of DE requires extensive expertise in laparoscopic surgery (8). Although the prediction of the intraoperative situs, i.e. extent and location of DE by performing TVS in combination with the #Enzian classification is feasible, there are no studies exploring correlation between presurgical imaging and actual surgical steps needed to be performed in order to surgically treat DE. Hence, the aim of the present work is to assess the correlation between presurgical findings reflected by TVS applying the #Enzian classification with surgical complexity. Additionally, correlation between presurgical TVS findings and intraoperative situs as well as pain symptoms will be assessed.
Methods and Skills:
Darici E, Denkmayr De, Pashkunova D, Dauser B, Birsan T, Hudelist G: Long-term surgical outcomes of nerve-sparing discoid and segmental resection for deep endometriosis. Acta Obstet Gynecol Scand 101: 972-977, 2022