Surgical planning for deep or complex endometriosis often depends on accurate preoperative assessment to estimate operative time and anticipate intraoperative findings. This prospective randomized multicenter pilot study evaluated whether adding clinical Enzian scoring and/or digital rectal examination (DRE) to routine assessment improves the accuracy of predicted operative time and whether these diagnostic strategies affect surgical outcomes.
The trial was a prospective, randomized, multicenter pilot trial conducted at three urban teaching hospitals certified as endometriosis centers. The publication type is a randomized controlled trial in Arch Gynecol Obstet. The report cites trial registration under DRKS00040760.
A total of 107 women scheduled for surgery for endometriosis were enrolled. Participants were randomized into three arms. The abstract does not report detailed baseline demographics, inclusion/exclusion criteria, or surgeon-level factors in the provided text.
Participants were allocated to one of three diagnostic strategies prior to surgery:
All patients additionally underwent standard transvaginal ultrasound examinations as part of routine preoperative assessment. The abstract does not provide further details on how Enzian scoring was standardized across centers or on examiner training and blinding.
The primary endpoint was defined as an absolute difference of ≤ 10 minutes between the estimated operative time (preoperative estimate) and the actual operative time recorded intraoperatively. The trial reported the number and proportion of patients in each group who met this threshold.
Secondary endpoints included conversion to laparotomy, abandonment of the operation, complete resection rate, need for secondary surgery, concordance between preoperative Enzian assessment and intraoperative findings, postoperative pain measured by visual analog scale (VAS), and patient satisfaction. These outcomes were prespecified and reported comparatively across the three groups in the abstract.
Primary endpoint achievement by group was reported as follows:
An exploratory comparison of the three groups did not demonstrate a statistically significant difference in the proportion of accurate operative time estimations.
Regarding the secondary endpoints, the abstract states that conversion rate to laparotomy, abandonment of the operation, complete resection rate, reoperation rate, and patient-reported outcomes (including postoperative pain and satisfaction) were comparable across groups. Specific rates, numerical details for these secondary outcomes, and corresponding p values or confidence intervals are not provided in the abstract text.
The abstract also notes that correspondence between preoperative Enzian assessment and intraoperative findings was evaluated as a secondary endpoint; however, detailed concordance metrics are not reported in the provided abstract.
In this randomized multicenter pilot trial of 107 women undergoing surgery for endometriosis, neither preoperative clinical Enzian scoring, digital rectal examination, nor the combination of both produced a measurable improvement in predicting operative time using the predefined ≤ 10-minute threshold. Secondary surgical outcome parameters and patient-reported measures were also comparable between groups.
These findings suggest that, within the context and methods reported in this pilot study, adding clinical Enzian scoring and/or DRE to standard assessment (including transvaginal ultrasound) did not meaningfully enhance operative time estimation or alter short-term surgical outcomes. The results are limited to what is reported in the abstract; the full text would be needed to assess methodological details, statistical analyses, subgroup findings, and potential implications for clinical pathways or scheduling.
The study is registered under DRKS00040760. The authors declared no competing interests in the conflict of interest statement.
The abstract does not provide several details that readers may seek when interpreting results: the statistical methods and significance levels used for comparisons; power calculations or sample-size justification for the primary endpoint; detailed patient baseline characteristics and comorbidities; information on surgeon experience, operative complexity grading, or intraoperative events beyond the listed secondary endpoints; and granular concordance data between preoperative Enzian and intraoperative findings. These elements are not reported in the abstract and would require consultation of the full manuscript for clarification.
Overall, the pilot randomized trial reports that neither Enzian scoring nor DRE, alone or combined, improved the precision of operative time estimates or altered operative outcomes in this multicenter cohort of women undergoing surgery for endometriosis.