🩸 Deep Infiltrating Endometriosis Surgery Simulator

Deep Infiltrating Lesion Identified

Endometriosis tissue invades more than 5mm beneath the peritoneal surface.

• >5 mm: DIE depth threshold (below peritoneum)
• ~20%: Prevalence in endometriosis (of diagnosed cases)
• 3: Common sites (rectum, bladder, septum)
• ~7 yrs: Diagnostic delay (average time to diagnosis)

What defines deep infiltration

Lesions grow past the peritoneal lining into deeper tissue planes.

Symptom pattern

Cyclical pelvic pain, dyschezia, and dyspareunia often signal DIE.

Why depth matters

Deeper lesions raise the odds of organ wall involvement.

Bowel/Bladder Involvement Assessed

Imaging maps how close the lesion sits to nearby organs.

• ~10%: Bowel involvement (of DIE cases)
• ~5%: Bladder involvement (of DIE cases)
• MRI: Preferred imaging (plus transvaginal ultrasound)
• ~90%: Sensitivity (expert US) (for bowel DIE)

Imaging modalities

MRI and expert ultrasound map lesion depth and organ contact.

Bowel wall layers

Involvement is graded by how many bowel wall layers are affected.

Bladder wall assessment

Cystoscopy checks whether lesions reach the bladder mucosa.

Surgical Excision Planning

A multidisciplinary team designs the safest excision approach.

• 3+: Team specialties (gynecology, colorectal, urology)
• 2: Shaving vs resection (main bowel techniques)
• 1–2: Planning meetings (pre-operative case reviews)
• Yes: Bowel prep required (for suspected resection)

Multidisciplinary review

Gynecologic, colorectal, and urologic surgeons align on approach.

Technique selection

Shaving, disc excision, or segmental resection depend on depth.

Patient counseling

Risks of stoma, leak, and fistula are discussed beforehand.

Excision Performed

The lesion is removed, with organ wall repair if needed.

• ~90%: Laparoscopic approach (of DIE excisions)
• ~30%: Bowel wall repair needed (of bowel resections)
• 2–4 h: Average operative time (complex DIE cases)
• ~85%: Complete excision rate (experienced centers)

Excision technique

Instruments dissect lesion tissue free from healthy organ wall.

Wall repair

Sutures close any bowel or bladder wall defect created.

Intraoperative testing

Leak tests confirm repair integrity before closure.

Complication Risk Evaluated

Fistula, leak, and organ injury risk are formally assessed.

• ~2–5%: Anastomotic leak rate (after bowel resection)
• ~1–3%: Rectovaginal fistula (reported incidence)
• ~1%: Bladder injury rate (in expert centers)
• 6 wks: Follow-up window (for complication monitoring)

Fistula risk

Weak repair sites can develop delayed fistula formation.

Leak risk

Anastomotic tension and blood supply drive leak risk.

Long-term monitoring

Follow-up imaging confirms healing and detects recurrence.