Current Endometriosis Classifications (rASRM, #Enzian, AAGL2021) and their Correlation with Operative Time

Abstract

Introduction

In the ongoing effort to identify or develop the optimal classification system for endometriosis, there is a paucity of data regarding the association between currently used classification systems and operative times. This study aims to evaluate the correlation between the rASRM, #Enzian, and AAGL2021 classifications and the duration of endometriosis surgery to determine the most accurate system for planning operating room resources.

Materials and Methods

This retrospective study included patients who underwent laparoscopic endometriosis surgery at Kepler University Hospital in 2021 and 2022. Surgeries were performed by experienced gynecologic surgeons, with endometriosis extent assessed using rASRM, #Enzian, and AAGL2021 classifications. Corrected operative time (total time minus fixed durations for common concomitant procedures) was used for analysis. Statistical analyses included descriptive statistics, Kendall’s tau correlation, Spearman’s correlation, Mann-Whitney U test, and generalized linear models.

Results

Out of 248 patients with laparoscopic surgery for endometriosis, 139 met the in-/exclusion criteria. The median corrected operative time was 68.50 minutes. Significant positive correlations were found between surgery duration and stages in both rASRM and AAGL2021 classifications. The #Enzian classification also showed positive correlations with more complex analyses attributable to the classification structure. Operative times were longest in surgeries affecting compartments C3, A3, FI, and FU. Regression analysis identified several significant variables impacting surgery duration.

Conclusions

All three classification systems significantly impact operative time, with higher stages or specific coding correlating with longer durations. The AAGL2021 and #Enzian classifications can be used as preoperative diagnostic tools, with #Enzian offering more detailed coding. Future research should focus on prospective, multi-center studies to develop algorithms incorporating #Enzian codings for enhanced preoperative planning.

Zusammenfassung

Einleitung

Bei den laufenden Bemühungen, die optimale Klassifikation für Endometriose zu identifizieren oder zu entwickeln, gibt es aktuell nur wenige Daten zum Zusammenhang zwischen derzeit existierenden Klassifikationssystemen und der Dauer von Endometriose-Operationen. Ziel dieser Studie war es, die Korrelation zwischen den rASRM-/#Enzian-/AAGL2021-Klassifikationen und der Operationsdauer zu evaluieren, um das geeignetste System für die Planung von OP-Ressourcen zu ermitteln.

Material und Methodik

In diese retrospektive Studie wurden alle Patientinnen eingeschlossen, die sich 2021 oder 2022 am Kepler Universitätsklinikum einer laparoskopischen Endometriose-Operation unterzogen haben. Die Operationen wurden von erfahrenen gynäkologischen Chirurgen durchgeführt, die das Ausmaß der Endometriose anhand der Klassifikationen rASRM, #Enzian und AAGL2021 beurteilten. Für die Analyse wurden korrigierte Operationszeiten (Gesamtzeit minus festgelegter Dauer für häufige Begleiteingriffe) verwendet. Die statistischen Analysen umfassten deskriptive Statistik, Kendall-Tau-Korrelation, Spearman-Korrelation, Mann-Whitney-U-Test und verallgemeinerte lineare Modelle.

Ergebnisse

139 von insgesamt 248 Patientinnen mit laparoskopischer Endometriose-Operation erfüllten die Ein- und Ausschlusskriterien. Die mediane korrigierte Operationszeit betrug 68,50 Minuten. Es zeigten sich signifikant positive Korrelationen zwischen der Operationsdauer und den rASRM- wie auch den AAGL2021-Stadien. Auch die #Enzian-Klassifikation zeigte positive Korrelationen, bei jedoch komplexeren Analysen aufgrund der Klassifikationsstruktur. Die längsten Operationszeiten traten bei Beteiligung der Kompartimente C3, A3, FI und FU auf. Eine durchgeführte Regressionsanalyse identifizierte mehrere signifikante Variablen, die sich auf die Operationsdauer auswirkten.

Schlussfolgerungen

Alle 3 Klassifikationssysteme zeigen signifikante Korrelationen zur Operationszeit, wobei höhere Stadien oder spezifische Kodierungen mit einer längeren OP-Dauer assoziiert sind. Die AAGL2021- und #Enzian-Klassifikationen können präoperativ eingesetzt werden, wobei #Enzian eine detailliertere Kodierung bietet. Zukünftig sollten Algorithmen zur Planung von OP-Zeiten unter Einbezug von #Enzian-Kodierungen entwickelt und in prospektiven, multizentrischen Studien getestet werden.

Keywords

endometriosis - surgery time - #Enzian - AAGL2021 - rASRM

Schlüsselwörter

Endometriose - Operationsdauer - #Enzian - AAGL2021 - rASRM

Publikationsverlauf

Eingereicht: 25. April 2025

Angenommen nach Revision: 30. August 2025

Artikel online veröffentlicht:
25. September 2025

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