Available online 7 November 2022, 102500

ABSTRACT

Deep infiltrating pelvic endometriosis and its surgical management is associated with a risk of major postoperative complications. Magnetic Resonance Imaging (MRI) is recommended preoperatively in order to obtain the most precise mapping of the extent of endometriotic lesions. The aim of this work was to assess the feasibility and clinical interest of 3D modeling by surface rendering as a preoperative planning tool in a patient with deep infiltrating pelvic endometriosis. We report on a 42 years old patient with history of endometriosis and persistent pain underwent pre operative imaging with MRI that was consistent with deep infiltrating endometriosis. A 3D model of the deep infiltrating endometriosis was generated from the MRI and retrospectively compared to the intra-operative findings. The nodule's location and relationship to the uterus and the rectum was clearly defined by the 3D model and correlated with surgical findings. Virtual reality based on 3D models could be an interesting tool to assist in the preoperative planning of complex surgeries.

Section snippetsINTRODUCTION

Deep infiltrating endometriosis (DIE) is the most severe and morbid form of endometriosis, frequently impairing fertility and affecting women's quality of life (QoL). DIE may result in significant organ damage including genitourinary tract obstruction, renal damage, or bowel obstruction. In case of DIE although medical therapy may be effective in many cases, the surgical approach is often required inexperthandscomplementedby an experienced team.

Surgical treatment of these women often requires

TECHNIQUE

Pelvic MRI was performed in the supine position by using a 3Tesla (3T) magnet before surgery. Sequences acquired included axial, sagital and coronal T2 weighted, axial and sagital T1 weighted before and after the administration of 11mL of Intravenous contrast (Dotarem). Sequences of Uro MRI were added to the protocol. Finally, 3D MRI acquisition was performed (Figure 1).

Retrospectively, we post processed MRI images previously performed in order to obtain 3D MRI reconstruction. MRI images in a

CASE

This is an obese primiparous 42 years old patient with a BMI of 30kg / m2. She has no history of abdominal or pelvic surgery. The patient presents disabling dysmenorrhea associated with dyschezia and catamenial rectal bleeding. The symptoms are persistent despite continuous macroprogestogen treatment. The clinical examination reveals a very tender uterus. The vaginal examination finds a bulky nodule of the recto vaginal septum. The preoperative pelvic MRI (Figure 1 and 2) reveals a large nodule

DISCUSSION

Our work assesses the feasibility of 3D modeling by surface rendering from MRI images for DIE. The 3D model representation of deep infiltrating endometriosis correlated well with the intra-operative findings with this first experience. Clinical value of 3D modeling could be interesting. Most of the surgeons reported a special interest and satisfaction with the model. Our work, due to the lack of currently available data, could represent an innovation in the field of endometriosis pathology and

Uncited References

[7]

Conflict of interest

The authors declare that they have no conflict of interest.

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