Efficacy of Targeted Vasopressin Injection at the Rectovaginal Deep Infiltrating Endometriosis During Laparoscopic Surgery : A Randomized Clinical Trial.

STUDY

OBJECTIVE

To evaluate the efficacy of targeted vasopressin injection at the rectovaginal deep infiltrating endometriosis (DIE) during laparoscopic dissection.

DESIGN

Patient-blinded randomized clinical trial from January 2023 to January 2024.

SETTING

Tertiary university hospital.

PATIENTS: Women aged 20 to 50 years with DIE stage III/IV.

INTERVENTIONS: In laparoscopic surgery, in the intervention group, 20 units/mL of vasopressin, diluted in 300 mL of normal saline, was precisely injected into the rectovaginal DIE nodules). In the control group, an equal volume of saline was injected at the same sites.

MEASUREMENTS: Surgical time, intraoperative bleeding, hemoglobin drop, surgical complications, and surgeon satisfaction were measured as the study outcomes.

RESULTS

There was no significant difference between the two groups in demographic characteristics, except for primary infertility. The results of the present study showed that in laparoscopic surgery for pelvic endometriosis, the injection of Vasopressin significantly reduced the duration of the surgery (p = .016), decreased bleeding and hemoglobin drop (p = .034), surgery complications (p = .041), and increased surgeon satisfaction (p <.001) about the dissection of endometriosis tissue and anatomical differentiation of the pelvic organs compared to saline injection. In addition, 30 and 14 patients in the intervention group and 23 and 8 patients in the control group, respectively, complained of dysmenorrhea and dyspareunia. The findings showed that postoperative dysmenorrhea and dyspareunia in the intervention group decreased to 2 and 2 patients, respectively, and in the control group, they decreased to 2 and 1 patients, respectively.

CONCLUSION

Targeted vasopressin injection at the rectovaginal DIE lesion as a simple way facilitates laparoscopic dissection by reducing operative time and bleeding, improving anatomical visualization, and decreasing surgical complications. The study's limitations may have affected the findings; future comprehensive studies are needed to confirm our findings.