Recurrence rate and fertility outcome after diode laser treatment of deep endometriosis: a 3-year follow-up study

Background To assess postoperative recurrence rates and likelihood of natural conception in women with deep endometriosis who underwent laparoscopic treatment with diode laser. Methods This is a retrospective study with prospective recording of data. Sixty patients underwent laparoscopic endometriosis lesions/nodules excision using a diode laser (Leonardo®, Biolitec® DUAL 45) that can combine 980 and 1470 nm wavelengths transmitted through a 1000 micron conical optical fiber between October 2017 and May 2019 at two University hospitals (Monserrato (CA) and Foggia, Italy). Indications for surgery were chronic pelvic pain and/or infertility in patients who wished to conceive spontaneously. After surgery, patients were incorporated in a prolonged surveillance program with periodic clinical follow- up to check for recurrence endometriosis lesions and/or recurrence of symptoms. Endometriosis recurrences were identified by transvaginal ultrasound or Magnetic Resonance Imaging (MRI). Patients wishing to become pregnant were allowed to attempt a spontaneous conception after surgery. If spontaneous conception failed, patients were referred for in vitro fertilization (IVF) and excluded from the study. Results The mean follow-up was 31 +/- 12 months (range, 24−44). Recurrence of deep endometriosis was recorded in 6.6% of patients (n = 4) managed with diode fiber laser. Recurrence of endometriosis-related pain was observed in 5 patients (8.3%). The presence of retro-rectal deep endometriosis lesion at the time of surgery was identified as the only independent poor prognostic indicator for endometriosis recurrence (p = .006; odds ratio [OR], 2.19; 95% confidence interval [CI], 1.21−3.12). Moreover, the discontinuation of hormonal treatment was independent poor prognostic indicators for pain recurrence. Twenty five patients (41.6%) tried to spontaneously conceive after laparoscopic treatment and 15 (60%) of these women achieved pregnancy. Conclusions Our study showed an appropriate surgical technique and during the shaving surgical procedure, the diode laser system ensures a safe and effective laparoscopic dissection of deep endometriotic lesions with recurrence and pregnancy rates comparable with those occurring using other types of energ