Minimally Invasive Surgery for Deep Infiltrating Endometriosis of the Bowel

PROGRAM: 

1. Welcome and Introduction

2. Case Presentation

1. Patient: 38-year-old female, BMI of 20 kg/m2. No previous abdominal surgery. Symptomatic for deep dyspareunia and chronic pelvic pain despite the hormonal therapy with dienogest. The transvaginal ultrasound showed a diffuse posterior uterine wall adenomyosis, right bilocular endometrioma and a deep endometriosis nodule affecting the recto-sigmoid junction.  

2. Procedure: Operative laparoscopy and mini-laparotomy.

3. Surgical Procedure - Steps

1. Diagnostic Laparoscopy

2. Adhesiolysis

3. Dissection of right medial pararectal space

4. Dissection of left medial pararectal space

5. Excision of right ovarian endometrioma

6. Excision of posterior uterine wall adenomyosis

7. Right ovarian suspension

8. Excision of recto-sigmoidal DIE nodule with nerve-sparing shaving technique

4. Closing remarks