Jordanna Diniz Osaki

Endometriosis is a chronic, estrogen-dependent inflammatory disease influenced by complex neuroimmune interactions and pain chronification mechanisms. Modern medical management is increasingly guided by a deeper understanding of neuroinflammation, peripheral and central sensitization, and immune dysregulation, moving beyond traditional hormonal suppression. This chapter will synthesize the latest evidence on precision medicine approaches, integrating pain phenotyping, molecular and inflammatory biomarkers, and mechanisms of treatment resistance. It will explore targeted pharmacologic strategies, including neuromodulators, selective progesterone receptor modulators, immunomodulatory and anti-fibrotic agents, as well as innovative non-hormonal therapies under investigation. Additionally, it will highlight research gaps and opportunities for translational applications. The aim is to provide a rigorous, mechanism-based framework for individualized, effective, and biologically informed medical treatment of endometriosis.

Surgical duration for endometriosis treatment varies based on the anatomical complexity of the disease and the surgical technique applied. However, the independent effects of each of these factors remain poorly understood. We hypothesized that intestinal involvement and the presence of endometrioma, whether isolated or combined, significantly increase operative time, regardless of the surgical technique. This study aimed to assess how endometriosis phenotype and surgical approach influence operative time. This retrospective observational study included 263 patients who underwent either conventional laparoscopy (n = 113) or robotic-assisted surgery (n = 150) between January 2020 and December 2024. Patients were stratified into four groups: (1) isolated deep infiltrating endometriosis, (2) endometrioma without intestinal involvement, (3) intestinal endometriosis without endometrioma, and (4) combined presentation (endometrioma with intestinal involvement). Univariate analyses and multiple linear regression models were used to examine the effects of disease phenotype and surgical approach on operative time. A p value < 0.05 was considered statistically significant. The presence of endometrioma and intestinal involvement were both significant predictors of increased operative time, with a cumulative effect in combined cases. Compared to isolated DIE, there was an average increase of 63.4 min for isolated endometrioma cases (p < 0.001), 40.9 min for isolated intestinal endometriosis (p = 0.004), and 103.8 min for combined presentation (p < 0.001). The robotic approach added an average of 34.0 min to operative time (p < 0.001), with the effect most pronounced in patients with endometrioma. Age was also a significant factor, contributing an additional 1.5 min per year (p = 0.035). The estimated mean docking time for robotic cases was approximately 12 min. When stratified by disease subtype, only the isolated endometrioma group showed a statistically significant difference between surgical techniques, with robotic-assisted surgery adding 55 min (p = 0.007). In the other groups, including those with intestinal involvement, no significant differences were observed between approaches, although there was a numerical trend towards longer operative times with the robotic technique. Operative time is primarily influenced by the clinical presentation of endometriosis, with endometrioma, especially when combined with intestinal involvement, having the greatest impact. Although robotic-assisted surgery was associated with longer operative times overall, it was more frequently used in complex cases, suggesting a positive selection bias. The additional time likely reflects both the technical intricacy of robotic procedures and the docking process. Nevertheless, this technology may offer advantages for complex dissections. These findings underscore the importance of individualized surgical planning based on the anatomical characteristics of the disease rather than solely on the choice of surgical platform.

Introduction: Laparoscopy has become a crucial tool in the diagnosis and treatment of gynecological acute abdomen. This minimally invasive technique not only allows for effective therapeutic interventions but also provides a reliable means of obtaining accurate diagnoses through direct visualization of abdominal and pelvic structures. It enables clinicians to identify underlying conditions, such as ectopic pregnancies, ovarian cysts, or pelvic inflammatory disease, with greater precision, reducing the need for exploratory laparotomy. This approach offers significant advantages, including reduced postoperative pain, and a shorter hospital stay. Methods: This descriptive retrospective study analyzed 39 female patients who underwent laparoscopy between 2017 and 2023, diagnosed with acute abdomen of gynecological origin, with the aim of describing the effect of laparoscopy in female patients with acute abdomen of gynecological origin, considering outcomes such as symptoms, intraoperative findings, postoperative hospital stay and complications occurring during the surgical procedure. Results: The most prevalent diagnosis was ectopic pregnancy (43.5%), followed by ruptured ovarian cyst (17.9%) and pelvic inflammatory disease (15.3%). Salpingectomy was the most common surgical procedure (48.7%), with a conversion rate to laparotomy of 10.2%. The average hospital stay was 1.9 ± 1.2 days, increasing for cases requiring surgical conversion (3.0 ± 1.8 days). Conclusion: We conclude that laparoscopy is effective in managing gynecological emergencies, providing rapid diagnoses, less invasive treatments, and shorter recovery times.

Introduction/Objectives: Endometriosis affects 10% of women worldwide. It is noteworthy that this condition is often accompanied by pelvic pain and stress. Endometriosis is a debilitating gynecological condition where tissue similar to the uterine lining grows outside the uterus, often causing significant pain and reproductive issues. We aimed to study the relationship between the intensity of pelvic pain, and stress and inflammatory markers in women with deep endometriosis. Methods: This cross-sectional study analyzed women diagnosed with deep endometriosis through imaging, surgery, and/or biopsy. We assessed pain using the Numerical Rating Scale (NRS). Stress was assessed with the Perceived Stress Scale (PSS-10) questionnaire and the serum cortisol levels. Additionally, we analyzed inflammatory markers, including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Results: Fifty-two women, with an average age of 37.8 ± 6.9 years, participated in this study. Forty-four percent of these participants demonstrated high levels of stress, as indicated by scores above 26 on the PSS-10. Those categorized with “high stress” on the PSS-10 questionnaire exhibited significantly higher pain levels compared to those with “low stress” (p < 0.05). Furthermore, patients experiencing more-severe pelvic pain (pain score > 7) had notably higher serum cortisol levels. Women with intense pelvic pain (scores above 7 on the NRS) had significantly elevated serum cortisol levels (Cohen’s d = 0.72; p = 0.018). Conclusions: A positive association was found between stress levels and the intensity of pelvic pain in women with deep endometriosis, suggesting an interconnection between emotional aspects and biological responses.