Anatomical Landmarks in Deep Endometriosis Surgery

Deep endometriosis (DE) represents a chronic inflammatory disease, affecting pelvic viscera and peritoneal and retroperitoneal structures and completely distorting their normal aspect and reciprocal relationships by a mechanism of progressive infiltration and retraction. One of the main objectives of its surgical treatment, together with reducing pelvic pain and improving fertility, is the restoration of normal pelvic anatomy. For this reason, surgeons must have a deep knowledge of pelvic anatomy, in order to reassess a grossly distorted surgical field. Thus, pelvic anatomical landmarks represent essential points of reference to start procedures such as mobilization of the pelvic viscera, wide peritoneal resections, or the identification of further anatomical structures to be preserved, such as parasympathetic and orthosympathetic pelvic neural fibers in nerve-sparing procedures.