- Email: [email protected]
1233 Impact of Endometriosis on Surgical Outcomes in Total Laparoscopic Hysterectomy
S178
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Virtual Poster Session 3: Endometriosis (10:00 AM − 10:10 AM)
Interventions: None. Measurements and Main Results: Tumor tissues and peripheral blood samples were obtained during surgery from patients with endometriosis and non-endometriotic tumors. The levels of VSIG4 mRNA, VSIG4 protein expression in tumor tissue, and serum soluble VSIG4 concentration were compared between the endometriosis and control group. In addition, receiver operating characteristic (ROC) curve analysis was used to obtain optimal VSIG4 cut-off values for endometriosis prediction. After dividing the cohort using these optimized cut-off values, we examined the association between VSIG4 levels and the factors indicating endometriosis severity, VSIG4 levels and serum cancer antigen (CA)-125 levels. The expressions of VSIG4 mRNA, VSIG4 protein, and serum VSIG4 concentration were significantly increased in the endometriosis group compared with the control group (P= 0.001, 0.002, and 0.049, respectively). The optimized VSIG4 mRNA, VSIG4 protein, and serum VSIG4 concentration cut-off values as determined by ROC curve analysis were 0.71, 0.32, and 144.37 pg/mL, respectively. After cohort division using these values, the proportion of women with increased VSIG4 levels was significantly greater in the higher CA-125 (≥ 24.88 U/mL) group compared with the lower CA-125 (< 24.88 U/mL) group (P= 0.015, 0.02, and 0.08, respectively). However, there was no association between VSIG4 levels and the factors indicating endometriosis severity. Conclusion: The expression of VSIG4 in endometriosis patients is increased compared with non-endometriotic tumor patients, and higher VSIG4 levels are significantly associated with higher serum CA-125 levels. This finding supports that VSIG40 s possible usefulness as a diagnostic biomarker for endometriosis.
10:00 AM: STATION R 2172 Effect of GNRH Antagonist, Elagolix on Size and Quantity of Endometriotic Lesions Following 2 Months of Therapy Stemmer SM,1,* Chacko AA2. 1Obstetrics & Gynaecology, Virtua Hospital, Voorhees, NJ; 2Kasturba Medical College, Mangalore, India *Corresponding author. Study Objective: Data on the effect of GnRH antagonist, Elagolix on pathological lesions of endometriosis is lacking. We present a case where second look laparoscopy was done on a patient treated with Elagolix, where the effect of the drug on implants is described. Design: Case report and review of the English literature. Setting: Tertiary care hospital. Patients or Participants: A 39-year-old female patient. Interventions: A 39-year-old G3P2A1 female patient had long-standing history of dysmenorrhoea, deep pelvic pain, and dyspareunia controlled by oral contraceptives. She underwent laparoscopic bilateral tubal sterilization and multiple endometriotic implants were observed in the left uterosacral ligament, posterior cul-de-sac, and deep peritoneal pocket. Postoperatively the patient was started on Elagolix 150 mg daily. The patient’s symptoms improved, however, she requested surgery as a definitive treatment for her endometriosis. Therefore, laparoscopic resection and ablation of endometriotic implants were done two months after initiation of therapy with Elagolix. Measurements and Main Results: Following initiation of therapy with Elagolix, the patient reported a significant improvement in her symptoms and quality of life. On second look laparoscopy, a marked reduction in size and number of implants were observed. Histopathological evaluation of biopsy from a residual implant was consistent with endometriosis. Conclusion: Endometriosis is a chronic gynecological condition which often produces debilitating pain and infertility. Elagolix is a novel drug, which has been recently approved in the US for treatment of moderate to severe endometriosis-related pain. In this case report, a marked reduction of disease was observed both symptomatically and on direct visualization of lesions. There have been previous studies demonstrating the effect of Leuprolide, Danazol and aromatase inhibitors on endometriotic implants. However, more information is required to provide evidence on the effect of Elagolix on the disease process, duration of pain-free interval and recurrence of disease after cessation of therapy. Virtual Poster Session 3: Endometriosis (10:00 AM − 10:10 AM) 10:00 AM: STATION S 2807 Immunoregulatory Protein, V-Set and Immunoglobulin Domain-Containing 4 (VSIG4), is Overexpressed in Patients with Endometriosis Jeon GH,1,* Byun JM,2 Kim KT,3 Jeong DH2. 1Obstetrics and Gynecology, Haeundae Paik Hospital, Inje university College of Medicine, Busan, Korea, Republic of (South); 2Obstetrics and Gynecology, Busan Paik Hospital Inje university College of Medicine, Busan, Korea, Republic of (South); 3Obstetrics and Gynecology, Dong-eui Hospital, Busan, Korea, Republic of (South) *Corresponding author. Study Objective: VSIG4 has been identified as a potent negative regulator of T cell responses and is suggested to regulate anti-tumor immunity. This study investigates whether VSIG4 is significantly expressed in endometriosis patients and its potential as an endometriosis biomarker. Design: Cross-sectional study. Setting: University hospital. Patients or Participants: 42 endometriosis and 21 non-endometriotic tumor patients.
Virtual Poster Session 3: Endometriosis (10:00 AM − 10:10 AM) 10:00 AM: STATION T 2769 Laparoscopic Round Ligament Suspension for Dyspareunia in a Retroverted Uterus Baker T,1,* Ramirez CI,2 Gobern JM3. 1MIGS Division, Department of OB/GYN, San Antonio Military Medical Center, San Antonio, TX; 2MIGS Division, Obstetrics and Gynecology, San Antonio Military Medical Center, San Antonio, TX; 3Department of OB/GYN, Main Line Health, Wynnewood, PA *Corresponding author. Video Objective: This video shows the steps of laparoscopic round ligament suspension used to neutralize the position of a retroverted uterus in order to relieve deep dyspareunia. Setting: A 35 year-old nulliparous patient presented for gynecologic care due to dysmenorrhea and dyspareunia refractory to medical treatment. She was found to have a retroverted uterus and pain was reproduced with palpation of the fundus with an otherwise normal exam. After discussion of options for management she desired diagnostic laparoscopy with possible round ligament suspension to address her retroverted uterus. Interventions: During laparoscopic survey significant retroversion of the uterus was confirmed with no other etiology for her pain identified. Laparoscopic round ligament suspension was completely in order to neutralize the angle of her uterus. There were no complications, the uterus was noted to remain axial at time of post-operative exam, and her dyspareunia was significantly improved. Conclusion: Laparoscopic suspension of the round ligament is a simple, straightforward procedure that should be considered for patients with dyspareunia due to a retroverted uterus. Virtual Poster Session 3: Endometriosis (10:10 AM − 10:20 AM) 10:10 AM: STATION A 1233 Impact of Endometriosis on Surgical Outcomes in Total Laparoscopic Hysterectomy
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
S179
Jorgensen EM,1,* Modest AM,2 Awtrey CS,2 King LP2. 1Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; 2OB/GYN, Beth Israel Deaconess Medical Center, Boston, MA *Corresponding author.
work-up including renal functions tests and pelvic imaging. Ureteral reimplantation for severe distal disease must be considered.
Study Objective: Presence of endometriosis is commonly believed to make surgery more complex; however, there is a paucity of data to support and elaborate upon this idea. We aim to describe the incidence of endometriosis among patients undergoing total laparoscopic hysterectomy (TLH), as well as the impact of endometriosis on surgical complications and reimbursement. Design: Retrospective cohort. Setting: 147 academic or community-based hospitals in the United States participating in the American College of Surgeons National Surgical Quality Improvement Program. Patients or Participants: Patients undergoing TLH for benign indications from 2014 to 2017. Interventions: Presence or absence of endometriosis was determined by chart and operative note review by trained research assistants, rather than reliance on diagnosis codes. Measurements and Main Results: A total 29,243 TLH’s were identified. Endometriosis was noted in 16.5% of all patients undergoing TLH for benign indications. Though more prevalent among white patients, endometriosis is common among black patients undergoing TLH (16.7% white versus 12.8% black, p<0.001). Only 10.5% of patients with endometriosis documented at the time of hysterectomy underwent concomitant excision or ablation of endometriosis. Perioperative complications were more common among patients with endometriosis (5.1% versus 4.4%, p=0.04). Hysterectomies in patients with endometriosis noted intraoperatively earned a lower average number of work relative value units (wRVU’s) compared to hysterectomies in patients without endometriosis (16.1 versus 16.3, p<0.001). Conclusion: Endometriosis is a common finding at the time of benign TLH; however, peritoneal endometriosis is rarely treated at the time of hysterectomy. Though patients with endometriosis are more likely to have surgical complications, their surgeries earn fewer wRVU’s than surgeries in patients without endometriosis. Given its prevalence, endometriosis should be well-understood by all practicing benign gynecologic surgeons.
10:10 AM: STATION C
Virtual Poster Session 3: Endometriosis (10:10 AM − 10:20 AM) 10:10 AM: STATION B 3034 Robotic-Assisted Ureteroneocystostomy and Psoas Hitch for Ureteral Endometriosis Awosogba TP,1,* Jan A,2 Zaid H3. 1Gynecology, Lahey Hospital and Medical Center, Boston, MA; 2Gynecology, Beth Israel Lahey Health, Burlington, MA; 3Urology, Lahey Hospital and Medical Center, Burlington, MA *Corresponding author. Video Objective: We present a case of extrinsic urethral endometriosis. We review the peri-operative management with renal function testing, preoperative imaging and stent placement. The patient had a robotic-assisted ureteroneocystostomy with psoas hitch for her severe disease. The goal of this video is to review peri-operative management of urinary tract endometriosis and to demonstrate the surgical technique of ureterolysis in extrinsic ureteral endometriosis and ureteroneocystostomy with psoas hitch. Setting: the patient was managed in the outpatient setting as well as the inpatient surgical suite. Interventions: Surgical: ureteroneocystostomy with psoas hitch. Conclusion: Ureteral endometriosis is a rare manifestation of pelvic endometriosis that can be managed with appropriately with a peri-operative
Virtual Poster Session 3: Endometriosis (10:10 AM − 10:20 AM)
2426 Sliding Sign Testing Could be a Potential Alternative to Laparoscopy to Predict Endometriosis Fertility Index (EFI) in Endometriosis Associated Infertility Alfaraj SA,1,* Bedaiwy M,2 Yong PJ,2 Allaire C,2 Williams C,2 Lisonkova S,3 Noga H4. 1Obstetric and Gynecology, Reproductive Endocrinology and Infertility, University of British Columbia, Vancouver, BC, Canada, Vancouver, BC, Canada; 2Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC, Canada; 3Obstetric and gynecology, University of British Columbia, Vancouver, BC, Canada; 4 Obstetric and Gynecology, Reproductive Endocrinology and Infertility, University of British Columbia, Vancouver, BC, Canada *Corresponding author. Study Objective: EFI is a robust tool to predict pregnancy rate in endometriosis patients who attempt non-in vitro fertilization conception. However, EFI calculation requires laparoscopy. Sliding sign is a newly established technique that can predict Pouch of Douglas (POD) obliteration with a high degree of accuracy. The objective of this study is to investigate the relationship between sliding sign and the EFI, and to explore the practicality of using sliding sign to predict EFI score less than seven. Design: Observational study from a prospective registry (Endometriosis Pelvic Pain Interdisciplinary Cohort (EPPIC), ClinicalTrials.gov#NCT 02911090). Analyzed data was captured from December 2013 to June 2017. Setting: Tertiary referral center at British Columbia Women’s Hospital. Patients or Participants: Eighty-six women who are less than 40 years old. Interventions: Dynamic ultrasonography for the sliding sign testing and EFI calculation during laparoscopic surgery. Measurements and Main Results: Patients with a negative sliding sign (N=26,Group I) were older, had stage IV endometriosis, and a lower median EFI score than patients who had a positive sliding sign (N=60, Group II).Patients in group I had significantly lower surgical factor scores, Regarding the EFI historical factors, group I participants had a longer duration of infertility with no significant difference in parity or age compared to group II. Logistic regression showed that an EFI score < 7 can be predicted with a high sensitivity of 87.9% and specificity of 81.1% with a negative sliding sign and EFI historical factors score. The area under the curve (AUC) was 0.93 (95% CI 0.85−0.99). Conclusion: The sliding sign could be a potential alternative to the EFI surgical factors, and it could be used in combination with EFI historical factors to predict an EFI score < 7 for patients who are not scheduled for immediate surgery. Virtual Poster Session 3: Endometriosis (10:10 AM − 10:20 AM) 10:10 AM: STATION D 2944 Transgluteal Pudendal Neurolysis Reinert AE,* Hibner M, Castellanos ME. OB/GYN, St Joseph’s Hospital and Medical Center, Phoenix, AZ *Corresponding author. Video Objective: To describe the surgical technique of pudendal neurolysis via a transgluteal route as performed at St Joseph’s Hospital and Medical Center in Phoenix, Arizona.
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Virtual Poster Session 3: Endometriosis (10:00 AM − 10:10 AM)
Interventions: None. Measurements and Main Results: Tumor tissues and peripheral blood samples were obtained during surgery from patients with endometriosis and non-endometriotic tumors. The levels of VSIG4 mRNA, VSIG4 protein expression in tumor tissue, and serum soluble VSIG4 concentration were compared between the endometriosis and control group. In addition, receiver operating characteristic (ROC) curve analysis was used to obtain optimal VSIG4 cut-off values for endometriosis prediction. After dividing the cohort using these optimized cut-off values, we examined the association between VSIG4 levels and the factors indicating endometriosis severity, VSIG4 levels and serum cancer antigen (CA)-125 levels. The expressions of VSIG4 mRNA, VSIG4 protein, and serum VSIG4 concentration were significantly increased in the endometriosis group compared with the control group (P= 0.001, 0.002, and 0.049, respectively). The optimized VSIG4 mRNA, VSIG4 protein, and serum VSIG4 concentration cut-off values as determined by ROC curve analysis were 0.71, 0.32, and 144.37 pg/mL, respectively. After cohort division using these values, the proportion of women with increased VSIG4 levels was significantly greater in the higher CA-125 (≥ 24.88 U/mL) group compared with the lower CA-125 (< 24.88 U/mL) group (P= 0.015, 0.02, and 0.08, respectively). However, there was no association between VSIG4 levels and the factors indicating endometriosis severity. Conclusion: The expression of VSIG4 in endometriosis patients is increased compared with non-endometriotic tumor patients, and higher VSIG4 levels are significantly associated with higher serum CA-125 levels. This finding supports that VSIG40 s possible usefulness as a diagnostic biomarker for endometriosis.
10:00 AM: STATION R 2172 Effect of GNRH Antagonist, Elagolix on Size and Quantity of Endometriotic Lesions Following 2 Months of Therapy Stemmer SM,1,* Chacko AA2. 1Obstetrics & Gynaecology, Virtua Hospital, Voorhees, NJ; 2Kasturba Medical College, Mangalore, India *Corresponding author. Study Objective: Data on the effect of GnRH antagonist, Elagolix on pathological lesions of endometriosis is lacking. We present a case where second look laparoscopy was done on a patient treated with Elagolix, where the effect of the drug on implants is described. Design: Case report and review of the English literature. Setting: Tertiary care hospital. Patients or Participants: A 39-year-old female patient. Interventions: A 39-year-old G3P2A1 female patient had long-standing history of dysmenorrhoea, deep pelvic pain, and dyspareunia controlled by oral contraceptives. She underwent laparoscopic bilateral tubal sterilization and multiple endometriotic implants were observed in the left uterosacral ligament, posterior cul-de-sac, and deep peritoneal pocket. Postoperatively the patient was started on Elagolix 150 mg daily. The patient’s symptoms improved, however, she requested surgery as a definitive treatment for her endometriosis. Therefore, laparoscopic resection and ablation of endometriotic implants were done two months after initiation of therapy with Elagolix. Measurements and Main Results: Following initiation of therapy with Elagolix, the patient reported a significant improvement in her symptoms and quality of life. On second look laparoscopy, a marked reduction in size and number of implants were observed. Histopathological evaluation of biopsy from a residual implant was consistent with endometriosis. Conclusion: Endometriosis is a chronic gynecological condition which often produces debilitating pain and infertility. Elagolix is a novel drug, which has been recently approved in the US for treatment of moderate to severe endometriosis-related pain. In this case report, a marked reduction of disease was observed both symptomatically and on direct visualization of lesions. There have been previous studies demonstrating the effect of Leuprolide, Danazol and aromatase inhibitors on endometriotic implants. However, more information is required to provide evidence on the effect of Elagolix on the disease process, duration of pain-free interval and recurrence of disease after cessation of therapy. Virtual Poster Session 3: Endometriosis (10:00 AM − 10:10 AM) 10:00 AM: STATION S 2807 Immunoregulatory Protein, V-Set and Immunoglobulin Domain-Containing 4 (VSIG4), is Overexpressed in Patients with Endometriosis Jeon GH,1,* Byun JM,2 Kim KT,3 Jeong DH2. 1Obstetrics and Gynecology, Haeundae Paik Hospital, Inje university College of Medicine, Busan, Korea, Republic of (South); 2Obstetrics and Gynecology, Busan Paik Hospital Inje university College of Medicine, Busan, Korea, Republic of (South); 3Obstetrics and Gynecology, Dong-eui Hospital, Busan, Korea, Republic of (South) *Corresponding author. Study Objective: VSIG4 has been identified as a potent negative regulator of T cell responses and is suggested to regulate anti-tumor immunity. This study investigates whether VSIG4 is significantly expressed in endometriosis patients and its potential as an endometriosis biomarker. Design: Cross-sectional study. Setting: University hospital. Patients or Participants: 42 endometriosis and 21 non-endometriotic tumor patients.
Virtual Poster Session 3: Endometriosis (10:00 AM − 10:10 AM) 10:00 AM: STATION T 2769 Laparoscopic Round Ligament Suspension for Dyspareunia in a Retroverted Uterus Baker T,1,* Ramirez CI,2 Gobern JM3. 1MIGS Division, Department of OB/GYN, San Antonio Military Medical Center, San Antonio, TX; 2MIGS Division, Obstetrics and Gynecology, San Antonio Military Medical Center, San Antonio, TX; 3Department of OB/GYN, Main Line Health, Wynnewood, PA *Corresponding author. Video Objective: This video shows the steps of laparoscopic round ligament suspension used to neutralize the position of a retroverted uterus in order to relieve deep dyspareunia. Setting: A 35 year-old nulliparous patient presented for gynecologic care due to dysmenorrhea and dyspareunia refractory to medical treatment. She was found to have a retroverted uterus and pain was reproduced with palpation of the fundus with an otherwise normal exam. After discussion of options for management she desired diagnostic laparoscopy with possible round ligament suspension to address her retroverted uterus. Interventions: During laparoscopic survey significant retroversion of the uterus was confirmed with no other etiology for her pain identified. Laparoscopic round ligament suspension was completely in order to neutralize the angle of her uterus. There were no complications, the uterus was noted to remain axial at time of post-operative exam, and her dyspareunia was significantly improved. Conclusion: Laparoscopic suspension of the round ligament is a simple, straightforward procedure that should be considered for patients with dyspareunia due to a retroverted uterus. Virtual Poster Session 3: Endometriosis (10:10 AM − 10:20 AM) 10:10 AM: STATION A 1233 Impact of Endometriosis on Surgical Outcomes in Total Laparoscopic Hysterectomy
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
S179
Jorgensen EM,1,* Modest AM,2 Awtrey CS,2 King LP2. 1Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; 2OB/GYN, Beth Israel Deaconess Medical Center, Boston, MA *Corresponding author.
work-up including renal functions tests and pelvic imaging. Ureteral reimplantation for severe distal disease must be considered.
Study Objective: Presence of endometriosis is commonly believed to make surgery more complex; however, there is a paucity of data to support and elaborate upon this idea. We aim to describe the incidence of endometriosis among patients undergoing total laparoscopic hysterectomy (TLH), as well as the impact of endometriosis on surgical complications and reimbursement. Design: Retrospective cohort. Setting: 147 academic or community-based hospitals in the United States participating in the American College of Surgeons National Surgical Quality Improvement Program. Patients or Participants: Patients undergoing TLH for benign indications from 2014 to 2017. Interventions: Presence or absence of endometriosis was determined by chart and operative note review by trained research assistants, rather than reliance on diagnosis codes. Measurements and Main Results: A total 29,243 TLH’s were identified. Endometriosis was noted in 16.5% of all patients undergoing TLH for benign indications. Though more prevalent among white patients, endometriosis is common among black patients undergoing TLH (16.7% white versus 12.8% black, p<0.001). Only 10.5% of patients with endometriosis documented at the time of hysterectomy underwent concomitant excision or ablation of endometriosis. Perioperative complications were more common among patients with endometriosis (5.1% versus 4.4%, p=0.04). Hysterectomies in patients with endometriosis noted intraoperatively earned a lower average number of work relative value units (wRVU’s) compared to hysterectomies in patients without endometriosis (16.1 versus 16.3, p<0.001). Conclusion: Endometriosis is a common finding at the time of benign TLH; however, peritoneal endometriosis is rarely treated at the time of hysterectomy. Though patients with endometriosis are more likely to have surgical complications, their surgeries earn fewer wRVU’s than surgeries in patients without endometriosis. Given its prevalence, endometriosis should be well-understood by all practicing benign gynecologic surgeons.
10:10 AM: STATION C
Virtual Poster Session 3: Endometriosis (10:10 AM − 10:20 AM) 10:10 AM: STATION B 3034 Robotic-Assisted Ureteroneocystostomy and Psoas Hitch for Ureteral Endometriosis Awosogba TP,1,* Jan A,2 Zaid H3. 1Gynecology, Lahey Hospital and Medical Center, Boston, MA; 2Gynecology, Beth Israel Lahey Health, Burlington, MA; 3Urology, Lahey Hospital and Medical Center, Burlington, MA *Corresponding author. Video Objective: We present a case of extrinsic urethral endometriosis. We review the peri-operative management with renal function testing, preoperative imaging and stent placement. The patient had a robotic-assisted ureteroneocystostomy with psoas hitch for her severe disease. The goal of this video is to review peri-operative management of urinary tract endometriosis and to demonstrate the surgical technique of ureterolysis in extrinsic ureteral endometriosis and ureteroneocystostomy with psoas hitch. Setting: the patient was managed in the outpatient setting as well as the inpatient surgical suite. Interventions: Surgical: ureteroneocystostomy with psoas hitch. Conclusion: Ureteral endometriosis is a rare manifestation of pelvic endometriosis that can be managed with appropriately with a peri-operative
Virtual Poster Session 3: Endometriosis (10:10 AM − 10:20 AM)
2426 Sliding Sign Testing Could be a Potential Alternative to Laparoscopy to Predict Endometriosis Fertility Index (EFI) in Endometriosis Associated Infertility Alfaraj SA,1,* Bedaiwy M,2 Yong PJ,2 Allaire C,2 Williams C,2 Lisonkova S,3 Noga H4. 1Obstetric and Gynecology, Reproductive Endocrinology and Infertility, University of British Columbia, Vancouver, BC, Canada, Vancouver, BC, Canada; 2Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC, Canada; 3Obstetric and gynecology, University of British Columbia, Vancouver, BC, Canada; 4 Obstetric and Gynecology, Reproductive Endocrinology and Infertility, University of British Columbia, Vancouver, BC, Canada *Corresponding author. Study Objective: EFI is a robust tool to predict pregnancy rate in endometriosis patients who attempt non-in vitro fertilization conception. However, EFI calculation requires laparoscopy. Sliding sign is a newly established technique that can predict Pouch of Douglas (POD) obliteration with a high degree of accuracy. The objective of this study is to investigate the relationship between sliding sign and the EFI, and to explore the practicality of using sliding sign to predict EFI score less than seven. Design: Observational study from a prospective registry (Endometriosis Pelvic Pain Interdisciplinary Cohort (EPPIC), ClinicalTrials.gov#NCT 02911090). Analyzed data was captured from December 2013 to June 2017. Setting: Tertiary referral center at British Columbia Women’s Hospital. Patients or Participants: Eighty-six women who are less than 40 years old. Interventions: Dynamic ultrasonography for the sliding sign testing and EFI calculation during laparoscopic surgery. Measurements and Main Results: Patients with a negative sliding sign (N=26,Group I) were older, had stage IV endometriosis, and a lower median EFI score than patients who had a positive sliding sign (N=60, Group II).Patients in group I had significantly lower surgical factor scores, Regarding the EFI historical factors, group I participants had a longer duration of infertility with no significant difference in parity or age compared to group II. Logistic regression showed that an EFI score < 7 can be predicted with a high sensitivity of 87.9% and specificity of 81.1% with a negative sliding sign and EFI historical factors score. The area under the curve (AUC) was 0.93 (95% CI 0.85−0.99). Conclusion: The sliding sign could be a potential alternative to the EFI surgical factors, and it could be used in combination with EFI historical factors to predict an EFI score < 7 for patients who are not scheduled for immediate surgery. Virtual Poster Session 3: Endometriosis (10:10 AM − 10:20 AM) 10:10 AM: STATION D 2944 Transgluteal Pudendal Neurolysis Reinert AE,* Hibner M, Castellanos ME. OB/GYN, St Joseph’s Hospital and Medical Center, Phoenix, AZ *Corresponding author. Video Objective: To describe the surgical technique of pudendal neurolysis via a transgluteal route as performed at St Joseph’s Hospital and Medical Center in Phoenix, Arizona.