Laparoscopic excision of bladder endometriosis
Epublication WebSurg.com, Mar 2012;12(03). URL: http://websurg.com/doi/vd01en3634
This is the case of a 34-year-old woman, G1P0010, with a long standing history of chronic pelvic and bladder pain occurring on a monthly basis. The patient has had laparoscopic diagnosis of endometriosis in the past with no resection performed at that time. Given cyclic bladder pain, the patient also underwent cystoscopy, which revealed an implant of bladder endometriosis measuring approximately 2cm in diameter. She has failed medical therapy including oral contraceptives and Lupron from several months. Given her continued bladder pain and severe dysmenorrhea and dyspareunia for the last 5 years, the decision was made to proceed with a surgical intervention. Operating room specificities: The patient was positioned in the dorsal lithotomy position with arms tucked bilaterally. A 12mm port was placed within the umbilicus for the laparoscope. A 5mm port was placed in the left lower quadrant about 2cm superior to the left anterior superior iliac spine. Another 5mm port was placed in the right upper quadrant about 8cm lateral and 2cm inferior to the umbilical port. A final 12mm port was placed in the right lower quadrant, about 2cm superior to the right anterior superior iliac spine. A 7cm clear view uterine manipulator was used. The primary surgeon was positioned on the left side of the patient. The main surgical assistant, the resident, was positioned on the right side of the patient. The secondary surgical assistant, the fellow, was positioned between the patient’s legs.