Journal of the American Association of Gynecologic Laparoscopists
Volume 11, Issue 2 , Pages 153-161 , May 2004

Deep Endometriosis: Definition, Pathogenesis, and Clinical Management

  • Paolo Vercellini, M.D.

      Affiliations

    • Clinica Ostetrica e Ginecologica I, Istituto Luigi Mangiagalli, University of Milan, Milan, Italy
    • Corresponding Author InformationCorresponding author Paolo Vercellini, M.D., Clinica Ostetrica e Ginecologica I, Istituto Luigi Mangiagalli, Universita di Milano, Via Commenda, 12, 20122 Milano, Italy
  • ,
  • Giada Frontino, M.D.

      Affiliations

    • Clinica Ostetrica e Ginecologica I, Istituto Luigi Mangiagalli, University of Milan, Milan, Italy
  • ,
  • Giuliana Pietropaolo, M.D.

      Affiliations

    • Clinica Ostetrica e Ginecologica I, Istituto Luigi Mangiagalli, University of Milan, Milan, Italy
  • ,
  • Umberto Gattei, M.D.

      Affiliations

    • Clinica Ostetrica e Ginecologica I, Istituto Luigi Mangiagalli, University of Milan, Milan, Italy
  • ,
  • Raffaella Daguati, M.D.

      Affiliations

    • Clinica Ostetrica e Ginecologica I, Istituto Luigi Mangiagalli, University of Milan, Milan, Italy
  • ,
  • Pier Giorgio Crosignani, M.D.

      Affiliations

    • Clinica Ostetrica e Ginecologica I, Istituto Luigi Mangiagalli, University of Milan, Milan, Italy

Received 5 August 2003 ,Accepted 7 January 2004.

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PII: S1074-3804(05)60190-9

doi: 10.1016/S1074-3804(05)60190-9

Journal of the American Association of Gynecologic Laparoscopists
Volume 11, Issue 2 , Pages 153-161 , May 2004