Facts, Views & Vision
in ObGyn

Journal of the European Society for Gynaecological Endoscopy

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Intra-operative and post-operative complications of endometriosis excision using the SOSURE approach — A single- surgeon retrospective series of 1116 procedures over 8 years

S. Khazali1*, A. Bachi1*, B. Mondelli2, K. Fleischer1, M. Adamczyk2, G. Delanerolle3, J. Q. Shi4, X. Yang5, P. Nisar2, P. Bearn2

*Equal first authors.

1 Centre for Endometriosis and Minimally Invasive Gynaecology (CEMIG London), HCA The Lister Hospital, Chelsea Bridge Road, London, United Kingdom, SW1W 8RH
2 Department of Obstetrics and Gynaecology, Ashford and St. Peter’s Hospital NHS Foundation Trust, Guildford Road, Chertsey, United Kingdom, KT16 0PZ
3 Digital Evidence Based Medicine Lab, Southern Health NHS Foundation Trust, Wessex Way, Colden Common, Winchester, United Kingdom, SO21 1WP
4 Department of Statistics and Data Science, Director Centre for Biostatistics, College of Science, Southern University of Science and Technology, 1088 Xueyuan Blvd, Nan Shan Qu, Shen Zhen Shi, Guang Dong Sheng, China, 518055
5 Department of Statistics and Data Science, College of Science, Southern University of Science and Technology, 1088 Xueyuan Blvd, Nan Shan Qu, Shen Zhen Shi, Guang Dong Sheng, China, 518055

Keywords:

Complications, endometriosis, excision surgery, single surgeon, structured approach


Published online: Sep 30 2024

https://doi.org/10.52054/FVVO.16.3.030

Abstract

Background: Endometriosis surgery outcomes have been widely studied, yet heterogeneity in terminology and techniques persist.

Objectives: This study focuses on the perioperative outcomes of a single surgeon using the same structured approach (SOSURE: Survey & Sigmoid mobilisation, Ovarian mobilisation, Suspension of uterus and ovaries, Ureterolysis, Rectovaginal and pararectal space development, Excision of all visible disease) and adheres to the recent standardised terminology proposed by international gynaecological and endometriosis societies.

Materials and methods: A quality improvement study was conducted retrospectively from January 2015 to January 2023. Data collection involved two databases: the National British Society for Gynaecological Endoscopy (BSGE) database and a more comprehensive locally kept database. The methodology also integrated four endometriosis staging systems.

Main outcome measures: Intra-operative and post-operative complication rates.

Results: Between 2015 and 2023, 1047 women underwent 1116 endometriosis procedures in various UK hospitals with S.K. as primary surgeon. Exclusions totalled 20 due to missing records and specific surgical criteria. The rate of major post-operative complications (Clavien-Dindo grade 3a and 3b) was 1.5% and minor post-operative complications (Clavien-Dindo grade 1 and 2) were seen in 13.8%. No Clavien-Dindo grade 4 or 5 complications were noted.

Conclusion: Our study has shown a low complication rate in endometriosis surgery, despite increasing complexity of surgical cases. This is likely attributed to the surgeon’s learning curve, high surgical volume and adherence to a structured approach.

What’s new? Our study demonstrates the learning curve of a surgeon over the course of 8 years. This series involved more than 1000 patients and to our knowledge, is the first to report the complexity of the casemix using four different endometriosis staging systems.