Laparoscopic Excision of Endometriosis and Disc Excision of the Bowel

PROGRAM:

1. Welcome and Introduction 

2. Case Presentation

1. Patient: 23-year-old female, previous laparoscopic ablation for deep endometriosis. Suffers from dysmenorrhea, dyschezia and chronic pelvic pain. Has tried various hormonal therapies and is currently using a Mirena coil.

2. Diagnostic: MRI reveals deep infiltrating endometriosis involving the posterior compartment, adjacent to the rectum, with involvement of the lateral pelvic sidewall and medial displacement of the right ureter.

3. Surgical Procedure - Steps

1. Entry and creation of pneumoperitoneum.

2. Complete 360-degree view for identification of endometriotic lesions.

3. Mobilization of the sigmoid colon.

4. Suspension of the right ovary.

5. Use of ICG to locate the right ureter.

6. Opening of the right pelvic sidewall.

7. Opening the right medial pararectal space, lateralizing the hypogastric nerve and ureter.

8. Confirming the ureter’s location with ICG.

9. Accessing the rectovaginal space and circumcising the lesion.

10. Further lateralization of the hypogastric nerve.

11. Debulking of the endometriotic nodule.

12. Suspension of the left ovary.

13. Opening the left medial pararectal space and isolating the left hypogastric nerve.

14. Mobilizing the bowel to access the rectovaginal space.

15. Shaving of the endometriotic nodule from the bowel’s serosal surface.

16. Identification and suturing of the bowel endometriosis nodule.

17. Bowel disc excision.

18. Performing an air leak test.

19. Checking the position of the right ureter and assessing bowel vascularization following disc excision.

4. Closing remarks