RESEARCH IN ENDOMETRIOSIS

Name	Position	Institution
Alicia Hernández Gutiérrez ............................	Facultativo Especialista de Área en Ginecología y Obstetricia. Unidad de Ginecología Oncológica Profesor Asociado. Facultad de Medicina	Hospital Universitario La Paz Universidad Autónoma de Madrid .............................................
Pedro N. Barri Soldevilla	Director del Departamento de Obstetricia, Ginecología y Reproducción Humana	Fundación Dexeus Mujer
Covadonga Álvarez López	Facultativo Especialista de Área en Ginecología y Obstetricia	Hospital Universitario La Paz
Mario Álvarez Maestro	Facultativo Especialista de Área en Urología	Hospital Universitario La Paz
Martina Aida Angelés Fité	Ginecóloga especialista en Oncología	Institut Universitaire Du Cancer De Toulouse
Ónica María Armijo Suárez	Facultativo Especialista de Área en Ginecología y Obstetricia. Unidad de Reproducción Asistida	Hospital Universitario La Paz
Myriam García Segovia	Médico Adjunto en Ginecología	Hospital Universitario La Paz
Juan Antonio García Velasco	Director Médico	IVI - RMA
Silvia Iniesta Pérez	Ginecóloga especialista en Reproducción	Hospital Ruber Internacional
Ana López Carrasco	Facultativo Especialista de Área en Ginecología y Obstetricia	Hospital Universitario La Paz
Alejandra Martinez Rodriguez-Marin	Subdirector del Departamento de Oncología Quirúrgica	Institut Universitaire Du Cancer De Toulouse
Blanca Martínez Serrano	Facultativo Especialista de Área en Anestesiología	Hospital Universitario La Paz
Cristina Redondo Guisasola	Facultativo Especialista de Área en Ginecología y Obstetricia	Hospital Universitario La Paz
Violeta Romero Camacho	Facultativo Especialista de Área en Ginecología y Obstetricia	Hospital Universitario La Paz
Patricia Isabel Salas Bolivar	Facultativo Especialista de Área en Ginecología y Obstetricia	Hospital Universitario La Paz
Emanuela Spagnolo	Facultativo Especialista de Área en Ginecología y Obstetricia	Hospital Universitario La Paz

Endometriosis is a debilitating gynaecological disease, responsible of pain and infertility with consequent worsening of women’s quality of life. The prevalence is estimated on 10% of the fertile age women, with an impact on quality of life and reproductive health. Despite its high prevalence and the great scientific activity generated around this disease, we are facing a problem whose etiology remains unknown. Although it is a chronic illness, which begins to cause symptoms very early in a large number of cases, there is still no predictive marker of the disease, no method of early diagnosis, or any way to modify its clinical course, which is highly variable, producing great uncertainty in affected women. Despite of great advances have been made in the treatment of the disease from a global perspective that included women's fertility and pain control, there is still no etiological treatment or any form of cure.

The endometriosis research group is committed to the following objectives in the next 5 years: to develop a scientific project for FIS 2023, to encourage young researchers, to organize a Master's Degree in Laparoscopy and Endometriosis, to increase the number of final degree projects and final master's projects, to improve the training of gynecological specialty trainee and promote internships abroad, to write publications of the results of our ongoing projects (mainly FIS 2020), to design a website for the HULP- Endometriosis group and to announce monthly workshops of patients with doctors and professionals from the Endometriosis Unit. We also set ourselves the challenge of recognizing the Endometriosis Unit-CSUR (National reference Unit) and promoting gender equality in research and innovation.

The strategies proposed to achieve these objectives are as follows: Participation in the FIBHULP "Mentor Program", to promote collaboration between senior researcher and junior researcher to carry out research projects, congresses communication, to enable specialist trainee and junior gynecologists to perform the "Winner Project", (an educational program for Endoscopic Gynecological Surgery with 3 levels of progression), to encourage collaboration with providers in the endoscopic sector such as Storz, Olympus and Striker. In addition, we have support from IdiPaz Biostatistics and IdiPAZ Biobank (PT20 / 00004) integrated into the National Network of Biobanks of Spain, technical assistance from the HULP Computer and Bioengineering Service, as well as active collaboration with national associations of patients and announcement of events in “La Paz Informa”.

• Investigation of biomarkers to predict the risk of endometriosis malignant transformation. Our objective is to identify a panel of immune system markers and specific genetic mutations to predict endometriosis patients at increased risk of developing ovarian cancer and to identify factors that allow the use of immunotherapy in this type of cancer. In both pathologies (endometriosis and ovarian cancer), the dysfunction of the immune system favours the progression of the disease. In February 2021, the Endometriosis Group received a Health Research Fund by Health Research Institut Carlos III for the project: “Molecular and immunological factors with predictive value in endometriosis associated ovarian cancer”.

• Clinical research and new technologies: the advantages of Fluorescence Guided Surgery (FGS). In our operating rooms (Hospital Maternal, HULP) we use modern technology that allows real-time visualization of certain anatomical structures and helps the surgeon to reduce intraoperative stress and improve performance. Recently, the intraoperative use of indocyanine green (ICG) has shown advantages in intestinal surgery for endometriosis. ICG is a dye that is injected intravenously and rapidly reaches the blood vessels of the abdominal organs and allows the emission of fluorescence in the spectral range of the infrared ray. In this way, the vascularization of the colorectal anastomosis can be assessed after bowel resection in patients with endometriosis. We are currently investigating the use of a macromolecule linked to ICG that allows the dye to remain longer in vascularized tissues (rectum), and with a single injection at the start of surgery. This technique is also useful for delimiting endometriotic nodules before removing them.