Deep Infiltrating Endometriosis Surgery

PROGRAM: 

1. Welcome and Introduction 

2. Case Presentation

1. Patient: 39 years old nulliparous woman, reporting chronic pelvic pain and dysmenorrhea, refractory to medical treatment, and a desire of pregnancy.  A complete investigation of fertility has been performed (AMH, OR and spermogram) demonstrating a normal fertility status. 

2. Other history: MRI reporting a 25 mm deep infiltrating endometriosis nodule of the right uterosacral ligament, involving the vagina, with no uterine infiltration, no rectal involvement, no adenomyosis and no ovarian involvement.  

3. Procedure: Operative laparoscopy aiming at fertility assessment by performing chromosalpingoscopy, and deep pelvic endometriosis resection with complete dissection of the uterus, vagina and rectum with a nerve-sparing approach.

3. Surgical Procedure - Steps

1. Sonicision preparing

2. Abdominal laparoscopic access 

3. Peritoneal cavity exploration

4. Sigmoid mobilization

5. Removal of anterior pelvic peritoneum lesions 

6. Chromosalpingoscopy with Methylene blue injection

7. Ovarian suspension and uterine ventrofixation

8. Left pararectal space development

9. Left uterosacral ligament resection

10. Right pararectal space development

11. Rectal dissection with opening of the rectovaginal space

12. Vaginal infiltrating lesion resection

13. Vaginal suture

14. Rectal integrity test

15. Hemostasis and washing

4. Closing remarks