We use cookies to offer you an optimal experience on our website. By browsing our website, you accept the use of cookies.

Gynecology

Find all the surgical interventions, lectures, experts opinions, debates, webinars and operative techniques per specialty.
Laparoscopic rectal shaving for rectocervical endometriotic nodule
This is the case of a 32-year-old G0P0 woman presenting with severe dysmenorrhea, severe dyspareunia, and constipation. Pelvic examination showed a normal vagina, a fixed uterus, and mobile adnexae. Transvaginal ultrasonography (TvUSG) showed that the uterus and both ovaries were normal. A left parasalpingeal endometrioma (15mm), an obliterated Douglas pouch, as well as rectocervical and infiltrated rectal nodules (18mm and 0.6mm respectively) were also evidenced. Since bilateral ovaries were fixed to the pelvic sidewall, the operative strategy included bilateral ureterolysis and dissection of the hypogastric nerve and the pararectal fossa. Finally, the rectocervical nodule was mobilized by performing cervical and rectal shaving. The rectum was controlled by means of a methylene blue test. The final pathology was endometriosis.
H Altuntaş
Surgical intervention
1 year ago
4982 views
483 likes
2 comments
06:58
Laparoscopic rectal shaving for rectocervical endometriotic nodule
This is the case of a 32-year-old G0P0 woman presenting with severe dysmenorrhea, severe dyspareunia, and constipation. Pelvic examination showed a normal vagina, a fixed uterus, and mobile adnexae. Transvaginal ultrasonography (TvUSG) showed that the uterus and both ovaries were normal. A left parasalpingeal endometrioma (15mm), an obliterated Douglas pouch, as well as rectocervical and infiltrated rectal nodules (18mm and 0.6mm respectively) were also evidenced. Since bilateral ovaries were fixed to the pelvic sidewall, the operative strategy included bilateral ureterolysis and dissection of the hypogastric nerve and the pararectal fossa. Finally, the rectocervical nodule was mobilized by performing cervical and rectal shaving. The rectum was controlled by means of a methylene blue test. The final pathology was endometriosis.
Colorectal resection in deep endometriosis: multidisciplinary laparoscopic approach (colorectal and gynecologic surgical teams)
In this video, we present the clinical case of a 42-year-old woman with deep pelvic endometriosis with rectal infiltration. After hormone therapy, the patient was operated on due to chronic pain. A laparoscopic approach was performed by a multidisciplinary team including colorectal and gynecologic surgeons having a wide experience in this field.
A CT-scan, MRI, and colonoscopy were performed before the surgery showing a deep infiltrating endometriosis with anterior rectal bowel involvement in the images and normal colorectal mucosa in the endoscopy.
Under general anesthesia, the laparoscopic approach was performed with 4 trocars. Deep infiltrating endometriosis (DIE) required a hysterectomy and rectal resection to clean all the pelvic space. An end-to-end colorectal anastomosis was performed and the extraction of the specimen (uterus and rectum) was carried out transvaginally. The patient was discharged on postoperative day 4 without complications.
JF Noguera, MD, PhD, J Gilabert-Estelles, J Aguirrezabalaga, B López, J Dolz
Surgical intervention
1 year ago
2966 views
298 likes
0 comments
09:55
Colorectal resection in deep endometriosis: multidisciplinary laparoscopic approach (colorectal and gynecologic surgical teams)
In this video, we present the clinical case of a 42-year-old woman with deep pelvic endometriosis with rectal infiltration. After hormone therapy, the patient was operated on due to chronic pain. A laparoscopic approach was performed by a multidisciplinary team including colorectal and gynecologic surgeons having a wide experience in this field.
A CT-scan, MRI, and colonoscopy were performed before the surgery showing a deep infiltrating endometriosis with anterior rectal bowel involvement in the images and normal colorectal mucosa in the endoscopy.
Under general anesthesia, the laparoscopic approach was performed with 4 trocars. Deep infiltrating endometriosis (DIE) required a hysterectomy and rectal resection to clean all the pelvic space. An end-to-end colorectal anastomosis was performed and the extraction of the specimen (uterus and rectum) was carried out transvaginally. The patient was discharged on postoperative day 4 without complications.
Laparoscopic resection of endometriotic fibrotic nodule extending from the posterior lateral aspect of the uterus to the left pelvic sidewall, encasing the internal iliac vessels and adherent to the mid-sigmoid colon
Deep endometriosis is one of the most complex and risky surgeries. Its laparoscopic management requires a systematic approach, a good anatomical knowledge, and a high level of surgical competency.
This is the case of a 37-year-old lady presenting with a complex deep pelvic endometriosis. She had a long history of severe dysmenorrhea, colicky abdominal pain, back pain, and constipation. Imaging studies (MR) showed a large fibrotic endometriotic nodule extending from the posterior lateral aspect of the uterus to the left pelvic sidewall, encasing the internal iliac vessels, nerves, and adherent to a 4cm segment of the mid-sigmoid colon.
This patient has a complicated past history of left ureter ligation during a caesarean section (in 2011), which resulted in a left-sided nephrectomy in 2012. She got a pneumothorax complication, lung drainage, right-side thoracotomy in 2013, and finally a total pleurectomy in 2014.
A Wattiez, R Nasir, I Argay
Surgical intervention
2 years ago
5141 views
311 likes
1 comment
42:42
Laparoscopic resection of endometriotic fibrotic nodule extending from the posterior lateral aspect of the uterus to the left pelvic sidewall, encasing the internal iliac vessels and adherent to the mid-sigmoid colon
Deep endometriosis is one of the most complex and risky surgeries. Its laparoscopic management requires a systematic approach, a good anatomical knowledge, and a high level of surgical competency.
This is the case of a 37-year-old lady presenting with a complex deep pelvic endometriosis. She had a long history of severe dysmenorrhea, colicky abdominal pain, back pain, and constipation. Imaging studies (MR) showed a large fibrotic endometriotic nodule extending from the posterior lateral aspect of the uterus to the left pelvic sidewall, encasing the internal iliac vessels, nerves, and adherent to a 4cm segment of the mid-sigmoid colon.
This patient has a complicated past history of left ureter ligation during a caesarean section (in 2011), which resulted in a left-sided nephrectomy in 2012. She got a pneumothorax complication, lung drainage, right-side thoracotomy in 2013, and finally a total pleurectomy in 2014.
Severe complex endometriosis with ascites: laparoscopic management
Frozen pelvis due to endometriosis is one of the most complex and risky situations which surgeons sometimes face. Its laparoscopic management requires a systematic approach, a good anatomical knowledge and a high level of surgical competency. This is a frozen pelvis case secondary to a complicated severe endometriosis in a young nulliparous lady. She had hemorrhagic abdominal ascites secondary to endometriosis, with a sub-occlusive syndrome. Her disease was further complicated with upper abdominal and pelvic fibrosis with a large umbilical endometriotic nodule as well as splenic, omental and sigmoid endometriosis. This video demonstrates the strategy of the laparoscopic management of this condition.
A Wattiez, R Nasir, A Host
Surgical intervention
3 years ago
3863 views
161 likes
1 comment
31:22
Severe complex endometriosis with ascites: laparoscopic management
Frozen pelvis due to endometriosis is one of the most complex and risky situations which surgeons sometimes face. Its laparoscopic management requires a systematic approach, a good anatomical knowledge and a high level of surgical competency. This is a frozen pelvis case secondary to a complicated severe endometriosis in a young nulliparous lady. She had hemorrhagic abdominal ascites secondary to endometriosis, with a sub-occlusive syndrome. Her disease was further complicated with upper abdominal and pelvic fibrosis with a large umbilical endometriotic nodule as well as splenic, omental and sigmoid endometriosis. This video demonstrates the strategy of the laparoscopic management of this condition.
Laparoscopic treatment of bilateral endometriotic cysts
The different surgical approaches to ovarian endometriosis are the following: ovarian cystectomy, endometrioma fenestration and removal, or a technique combining cystectomy and removal.
In order to perform a cystectomy without damaging the ovary, different steps must be followed, including adhesiolysis between the ovary and the broad ligament, cyst opening at the site of eversion and adhesion. Traction and counter-traction allow to separate the cyst’s wall from the ovarian cortex. As the endometrioma is surrounded by a fibrotic capsule, there is a risk of removing normal ovarian tissue and ovocytes. Blood vessels must be identified and selective coagulation must be performed to prevent destruction of the normal ovarian tissue.
Endometrioma fenestration and removal can be performed with different sources of energy such as bipolar coagulation, carbon dioxide laser and plasma energy. Depending on the size of the endometrioma, the removal technique can be performed in one or three steps. But to avoid 2 laparoscopic procedures, a combined technique of excision and removal of the endometrioma could be offered in cases of large cysts.
Medical treatment is administered preoperatively only in cases of pelvic pain and postoperatively in cases of pelvic pain and if there is no desire for pregnancy.
According to a recent systematic review and meta-analysis, the ovarian reserve, evaluated by the AMH level, is affected by surgery, and even more in cases of bilateral cysts.

To conclude, ovarian endometrioma surgery requires a learning curve to prevent ovarian damage, which can be caused by normal ovarian tissue removal or by a strong coagulation. Repetitive surgery has to be clearly evaluated as it is also responsible for ovarian reserve decrease.
M Nisolle
Lecture
4 years ago
2439 views
94 likes
0 comments
19:00
Laparoscopic treatment of bilateral endometriotic cysts
The different surgical approaches to ovarian endometriosis are the following: ovarian cystectomy, endometrioma fenestration and removal, or a technique combining cystectomy and removal.
In order to perform a cystectomy without damaging the ovary, different steps must be followed, including adhesiolysis between the ovary and the broad ligament, cyst opening at the site of eversion and adhesion. Traction and counter-traction allow to separate the cyst’s wall from the ovarian cortex. As the endometrioma is surrounded by a fibrotic capsule, there is a risk of removing normal ovarian tissue and ovocytes. Blood vessels must be identified and selective coagulation must be performed to prevent destruction of the normal ovarian tissue.
Endometrioma fenestration and removal can be performed with different sources of energy such as bipolar coagulation, carbon dioxide laser and plasma energy. Depending on the size of the endometrioma, the removal technique can be performed in one or three steps. But to avoid 2 laparoscopic procedures, a combined technique of excision and removal of the endometrioma could be offered in cases of large cysts.
Medical treatment is administered preoperatively only in cases of pelvic pain and postoperatively in cases of pelvic pain and if there is no desire for pregnancy.
According to a recent systematic review and meta-analysis, the ovarian reserve, evaluated by the AMH level, is affected by surgery, and even more in cases of bilateral cysts.

To conclude, ovarian endometrioma surgery requires a learning curve to prevent ovarian damage, which can be caused by normal ovarian tissue removal or by a strong coagulation. Repetitive surgery has to be clearly evaluated as it is also responsible for ovarian reserve decrease.
DIE and laparoscopic treatment
Hormone therapy was designed to suppress estrogen synthesis and to reduce the size of ectopic endometrial implants. However, the recurrence of pain after cessation is estimated at 50% and indicates that surgery is required for symptomatic patients.
Conservative surgery is effective in terms of pain reduction if complete excision is obtained, and consequently a preoperative assessment is mandatory to put forward a multidisciplinary approach in specialized centers.
In cases of excision of the nodular lesion by means of mucosal skinning, the resection of uterosacral ligaments and of the posterior vaginal fornix is usually recommended. A comparison between standard and reverse laparoscopic techniques demonstrated a statistically significant lower rate of major postoperative complications by using the reverse technique.
Bowel endometriosis requires bowel resection if the size is estimated to exceed 3cm, to affect 50% of the bowel's diameter or to induce a stenosis. Different techniques could be proposed such as a segmental bowel resection, a discoid resection or a stapled resection.
Concerning the rate of complications, it has been published that mucosal skinning is associated with fewer complications than segmental resection.
Recently, robotic assisted laparoscopy was used for the treatment of advanced stage endometriosis; however, it is associated with an increased operative time and a longer hospital stay.

To conclude, a skilled surgical team is necessary to perform the complete removal of lesions without increasing the risk of complications and to obtain good results in terms of pelvic pain and fertility.
M Nisolle
Lecture
4 years ago
1786 views
78 likes
0 comments
23:49
DIE and laparoscopic treatment
Hormone therapy was designed to suppress estrogen synthesis and to reduce the size of ectopic endometrial implants. However, the recurrence of pain after cessation is estimated at 50% and indicates that surgery is required for symptomatic patients.
Conservative surgery is effective in terms of pain reduction if complete excision is obtained, and consequently a preoperative assessment is mandatory to put forward a multidisciplinary approach in specialized centers.
In cases of excision of the nodular lesion by means of mucosal skinning, the resection of uterosacral ligaments and of the posterior vaginal fornix is usually recommended. A comparison between standard and reverse laparoscopic techniques demonstrated a statistically significant lower rate of major postoperative complications by using the reverse technique.
Bowel endometriosis requires bowel resection if the size is estimated to exceed 3cm, to affect 50% of the bowel's diameter or to induce a stenosis. Different techniques could be proposed such as a segmental bowel resection, a discoid resection or a stapled resection.
Concerning the rate of complications, it has been published that mucosal skinning is associated with fewer complications than segmental resection.
Recently, robotic assisted laparoscopy was used for the treatment of advanced stage endometriosis; however, it is associated with an increased operative time and a longer hospital stay.

To conclude, a skilled surgical team is necessary to perform the complete removal of lesions without increasing the risk of complications and to obtain good results in terms of pelvic pain and fertility.
Management of a severe bleeding during laparoscopy for recurrent rectovaginal endometriosis
This case demonstrates the potential danger of a repetitive surgery after an incomplete resection of rectovaginal endometriosis. A severe bleeding occurred during the dissection of the recurrent nodule. It was managed through multiple coagulations, which could only be performed safely and effectively because important landmarks had been identified and retracted prior to resecting the nodule. A key point in the surgery was also circumventing the nodule in order to pass in sano as the bleeding came from vessels entrapped in fibrosis and scarring tissue which could not be effectively coagulated.
A Wattiez, R Murtada, G Centini, R Fernandes, K Afors, C Meza Paul, J Castellano
Surgical intervention
4 years ago
3173 views
59 likes
0 comments
08:06
Management of a severe bleeding during laparoscopy for recurrent rectovaginal endometriosis
This case demonstrates the potential danger of a repetitive surgery after an incomplete resection of rectovaginal endometriosis. A severe bleeding occurred during the dissection of the recurrent nodule. It was managed through multiple coagulations, which could only be performed safely and effectively because important landmarks had been identified and retracted prior to resecting the nodule. A key point in the surgery was also circumventing the nodule in order to pass in sano as the bleeding came from vessels entrapped in fibrosis and scarring tissue which could not be effectively coagulated.
Laparoscopic ileocaecal and sigmoid resection with transanal natural orifice specimen extraction (NOSE) for endometriosis
In 12 to 30% of endometriosis cases, the disease is located in the bowel. Caecum and small bowel endometriosis are found in only 3.6% and 7% respectively of those cases while the sigmoid colon and the rectum are most commonly affected in 85% of cases. The laparoscopic management of this disease has evolved drastically over the last decade, and even delicate cases such as small bowel endometriosis can be completely managed by laparoscopy. It is key to be locally invasive towards the disease but conservative with regards to organ function preservation. The specimen will be extracted through natural orifices and without any ileostomy. Our patients are commonly young and healthy women who will certainly benefit from a tailored surgery with immediate symptom relief in addition to minimum abdominal scarring can have a significant positive impact on patient’s psychological well-being and subsequent recovery.
In the present case, we present a 36-year old woman who was diagnosed with endometriosis and presented with 3 episodes of bowel pseudo-obstruction and dyschezia, and put under medical treatment. She was found to have multiple endometriotic nodules, with concurrent ileocaecal and rectosigmoid disease, for which a double bowel resection with transanal natural orifice specimen extraction (NOSE) was performed without complications.
A Wattiez, J Leroy, C Meza Paul, K Afors, J Castellano, G Centini, R Fernandes, R Murtada
Surgical intervention
4 years ago
1893 views
46 likes
0 comments
38:15
Laparoscopic ileocaecal and sigmoid resection with transanal natural orifice specimen extraction (NOSE) for endometriosis
In 12 to 30% of endometriosis cases, the disease is located in the bowel. Caecum and small bowel endometriosis are found in only 3.6% and 7% respectively of those cases while the sigmoid colon and the rectum are most commonly affected in 85% of cases. The laparoscopic management of this disease has evolved drastically over the last decade, and even delicate cases such as small bowel endometriosis can be completely managed by laparoscopy. It is key to be locally invasive towards the disease but conservative with regards to organ function preservation. The specimen will be extracted through natural orifices and without any ileostomy. Our patients are commonly young and healthy women who will certainly benefit from a tailored surgery with immediate symptom relief in addition to minimum abdominal scarring can have a significant positive impact on patient’s psychological well-being and subsequent recovery.
In the present case, we present a 36-year old woman who was diagnosed with endometriosis and presented with 3 episodes of bowel pseudo-obstruction and dyschezia, and put under medical treatment. She was found to have multiple endometriotic nodules, with concurrent ileocaecal and rectosigmoid disease, for which a double bowel resection with transanal natural orifice specimen extraction (NOSE) was performed without complications.
Laparoscopic treatment of a deep endometriotic nodule in the ischiatic tuberosity
In this challenging surgery performed by Professor Arnaud Wattiez, we present the case of a 39-year-old woman suffering from deep infiltrating endometriosis and infertility with no previous surgeries. The patient presented with chronic pelvic pain, dyschezia, and dyspareunia. Preoperative workup included MRI and rectosigmoidoscopy. MRI revealed a nodule at the level of the right uterosacral ligament. Rectosigmoidoscopy revealed a bulging of the anterior rectal wall located at 6cm from the anal verge where biopsy revealed fibrosis. The patient’s physical examination demonstrated the presence of a retrouterine nodule at the site of the right uterosacral ligament measuring 3cm.
A Wattiez, R Fernandes, M Puga, J Alves, C Redondo Guisasola
Surgical intervention
5 years ago
2014 views
35 likes
0 comments
03:00
Laparoscopic treatment of a deep endometriotic nodule in the ischiatic tuberosity
In this challenging surgery performed by Professor Arnaud Wattiez, we present the case of a 39-year-old woman suffering from deep infiltrating endometriosis and infertility with no previous surgeries. The patient presented with chronic pelvic pain, dyschezia, and dyspareunia. Preoperative workup included MRI and rectosigmoidoscopy. MRI revealed a nodule at the level of the right uterosacral ligament. Rectosigmoidoscopy revealed a bulging of the anterior rectal wall located at 6cm from the anal verge where biopsy revealed fibrosis. The patient’s physical examination demonstrated the presence of a retrouterine nodule at the site of the right uterosacral ligament measuring 3cm.
Laparoscopic segmental resection in a patient with deep infiltrating endometriosis
We present the case of a 33-year-old-woman suffering from deep infiltrating endometriosis. In her previous history, three laparoscopies had been performed due to endometriosis. In the first two laparoscopies, bilateral ovarian cystectomies had been carried out while the third laparoscopy had been indicated to puncture the ovaries after hormonal stimulation for in vitro fertilization (IVF), due to the impossibility of reaching follicles transvaginally.
The patient presented with dysmenorrhea, dyspareunia and dyschezia, as well as rectorrhagia and diarrhea. The patient’s physical examination demonstrated the presence of a retrouterine mass suggestive of adhesions. Preoperative work-up included MRI and colonoscopy. MRI showed an endometriotic nodule affecting the rectosigmoid junction and infiltrating its wall. A colonoscopy was performed and allowed to visualize the endometriotic nodule.
A Wattiez, C Redondo Guisasola, M Puga, J Alves, R Fernandes
Surgical intervention
5 years ago
2635 views
31 likes
0 comments
18:50
Laparoscopic segmental resection in a patient with deep infiltrating endometriosis
We present the case of a 33-year-old-woman suffering from deep infiltrating endometriosis. In her previous history, three laparoscopies had been performed due to endometriosis. In the first two laparoscopies, bilateral ovarian cystectomies had been carried out while the third laparoscopy had been indicated to puncture the ovaries after hormonal stimulation for in vitro fertilization (IVF), due to the impossibility of reaching follicles transvaginally.
The patient presented with dysmenorrhea, dyspareunia and dyschezia, as well as rectorrhagia and diarrhea. The patient’s physical examination demonstrated the presence of a retrouterine mass suggestive of adhesions. Preoperative work-up included MRI and colonoscopy. MRI showed an endometriotic nodule affecting the rectosigmoid junction and infiltrating its wall. A colonoscopy was performed and allowed to visualize the endometriotic nodule.
Segmental bowel resection and transanal specimen extraction for Deep Infiltrating Endometriosis (DIE)
Endometriosis can affect the bowel in 5-15% of cases and the most common sites are the rectum, the sigmoid colon, the appendix, and the small bowel. Patients may present dysmenorrhea, dyspareunia and chronic pelvic pain, as well as digestive symptoms such as dyschezia, constipation and diarrhea during menstruation. Preoperative work-up includes transanal ultrasound and magnetic resonance imaging, which according to the nodule’s location, can accurately describe the lesions. The laparoscopic approach includes adhesiolysis (shaving), partial thickness wall excision (mucosal skinning), discoid resection, and segmental bowel resection. In this video, we present the case of a 30-year-old patient complaining from severe dysmenorrhea, dyspareunia and dyschezia associated with deep infiltrating endometriosis (DIE) of the sigmoid colon that was treated by means of nodule excision, segmental bowel resection, and transanal specimen extraction.
A Wattiez, J Leroy, J Albornoz, E Faller, M Puga
Surgical intervention
6 years ago
2443 views
15 likes
0 comments
10:12
Segmental bowel resection and transanal specimen extraction for Deep Infiltrating Endometriosis (DIE)
Endometriosis can affect the bowel in 5-15% of cases and the most common sites are the rectum, the sigmoid colon, the appendix, and the small bowel. Patients may present dysmenorrhea, dyspareunia and chronic pelvic pain, as well as digestive symptoms such as dyschezia, constipation and diarrhea during menstruation. Preoperative work-up includes transanal ultrasound and magnetic resonance imaging, which according to the nodule’s location, can accurately describe the lesions. The laparoscopic approach includes adhesiolysis (shaving), partial thickness wall excision (mucosal skinning), discoid resection, and segmental bowel resection. In this video, we present the case of a 30-year-old patient complaining from severe dysmenorrhea, dyspareunia and dyschezia associated with deep infiltrating endometriosis (DIE) of the sigmoid colon that was treated by means of nodule excision, segmental bowel resection, and transanal specimen extraction.
Radical excision or bowel resection for deep endometriosis
In this key lecture, the author focuses on bowel endometriosis. This disease is often multifocal and there are 8% of resection margins which are not free despite segmental resection. Although bowel resection is widely performed, indications are poorly documented regarding nodule size or localization. Segmental resection at the level of the rectum is associated with bowel, bladder, and sexual complications as found in other conditions (such as cancer). The author insists on the need to first perform a discoid resection except if the size of the lesion takes up more than 50% of the wall area and exceeds 2-3cm. For this procedure, it is recommended that the operation be carried out by pelvic surgeons with perfect expertise in endometriosis.
P Koninckx
Lecture
7 years ago
1341 views
7 likes
1 comment
21:48
Radical excision or bowel resection for deep endometriosis
In this key lecture, the author focuses on bowel endometriosis. This disease is often multifocal and there are 8% of resection margins which are not free despite segmental resection. Although bowel resection is widely performed, indications are poorly documented regarding nodule size or localization. Segmental resection at the level of the rectum is associated with bowel, bladder, and sexual complications as found in other conditions (such as cancer). The author insists on the need to first perform a discoid resection except if the size of the lesion takes up more than 50% of the wall area and exceeds 2-3cm. For this procedure, it is recommended that the operation be carried out by pelvic surgeons with perfect expertise in endometriosis.
Mucosal skinning for bowel endometriosis: standard technique
Bowel endometriosis is described in 3% to 37% of patients with endometriosis. In 90% of these cases, the rectum, the sigmoid colon or both are involved. It is the most severe form of the disease and its surgical management is complex. Surgery is very challenging and the degree of radical excision should always be counterbalanced with the risk of complications and functional disorders. Four types of surgery can be chosen: superficial excision or shaving, mucosal skinning, discoid excision, and segmental bowel resection. We believe that bowel resection can be avoided in some cases if mucosal skinning is first attempted. This video shows 2 endometriotic lesions of the rectosigmoid junction that were treated by mucosal skinning, hence avoiding an unnecessary segmental resection. The final result was satisfactory and postoperative outcome was uneventful. In 2008, the patient underwent a laparoscopic intervention, which revealed the presence of a deep infiltrating endometriosis and bilateral endometriotic cysts. Bilateral ovarian cystectomy was performed. Postoperative MRI for pelvic pains revealed a persistent lesion of the recto-vaginal septum. The patient then presented with persistent dysmenorrhea (8/10), chronic pelvic pain (8/10), dyschezia (6/10) without dyspareunia or bladder-related symptoms. Clinical examination showed a mobile anteverted uterus without clear evidence of a nodule lesion at the rectovaginal septum neither was it at the level of uterosacral ligaments, but most probably the presence of adhesions between the uterus and the rectosigmoid junction. Despite treatment with GnRH agonist, the patient was referred to the emergency department several times for bouts of intense pain.
A Wattiez, E Faller, J Albornoz, P Messori, T Boisramé
Surgical intervention
7 years ago
1466 views
75 likes
0 comments
11:40
Mucosal skinning for bowel endometriosis: standard technique
Bowel endometriosis is described in 3% to 37% of patients with endometriosis. In 90% of these cases, the rectum, the sigmoid colon or both are involved. It is the most severe form of the disease and its surgical management is complex. Surgery is very challenging and the degree of radical excision should always be counterbalanced with the risk of complications and functional disorders. Four types of surgery can be chosen: superficial excision or shaving, mucosal skinning, discoid excision, and segmental bowel resection. We believe that bowel resection can be avoided in some cases if mucosal skinning is first attempted. This video shows 2 endometriotic lesions of the rectosigmoid junction that were treated by mucosal skinning, hence avoiding an unnecessary segmental resection. The final result was satisfactory and postoperative outcome was uneventful. In 2008, the patient underwent a laparoscopic intervention, which revealed the presence of a deep infiltrating endometriosis and bilateral endometriotic cysts. Bilateral ovarian cystectomy was performed. Postoperative MRI for pelvic pains revealed a persistent lesion of the recto-vaginal septum. The patient then presented with persistent dysmenorrhea (8/10), chronic pelvic pain (8/10), dyschezia (6/10) without dyspareunia or bladder-related symptoms. Clinical examination showed a mobile anteverted uterus without clear evidence of a nodule lesion at the rectovaginal septum neither was it at the level of uterosacral ligaments, but most probably the presence of adhesions between the uterus and the rectosigmoid junction. Despite treatment with GnRH agonist, the patient was referred to the emergency department several times for bouts of intense pain.
Ureteral endometriosis: general outcomes, our experience
This lecture presents ureteral endometriosis, which is a rare pathology (0.1% of cases). In 50% of cases, the condition is asymptomatic and can lead to loss of renal functions. In the literature, ureteral endometriosis increases with the presence of rectovaginal endometriosis, which does not appear in the study presented (221 cases of endometriosis, 19.5% of which are ureteral tract endometriosis). It seems to be significantly associated with uterosacral ligament (USL) endometriosis (p=0.01) but not with bladder endometriosis. Medical treatment is not indicated and conservative laparoscopic surgical management shows a long-term relief of symptoms and a low rate of anatomical recurrence (0-11%).
B Gabriel
Lecture
7 years ago
521 views
6 likes
0 comments
14:29
Ureteral endometriosis: general outcomes, our experience
This lecture presents ureteral endometriosis, which is a rare pathology (0.1% of cases). In 50% of cases, the condition is asymptomatic and can lead to loss of renal functions. In the literature, ureteral endometriosis increases with the presence of rectovaginal endometriosis, which does not appear in the study presented (221 cases of endometriosis, 19.5% of which are ureteral tract endometriosis). It seems to be significantly associated with uterosacral ligament (USL) endometriosis (p=0.01) but not with bladder endometriosis. Medical treatment is not indicated and conservative laparoscopic surgical management shows a long-term relief of symptoms and a low rate of anatomical recurrence (0-11%).
Complications of endometriosis surgery
This lecture focuses on complications in laparoscopic surgery for endometriosis. First, the expert addresses how to define complications. Surgeons sometimes need to remove part of the adjacent structures such as bowel, vagina and ureter, which should be included in the surgery – to achieve a complete excision of the disease. Complications can always occur and the most important thing to be borne in mind is to know how to deal with them by laparoscopy.
Complications may include adhesions, bowel, ureter and vascular injuries. The rate of complications in rectal shaving ranges from 0.2 to 1.4%. In case of discoid bowel resection, the morbidity rate published in the literature is 13%. Regarding rectal segmental resection, the rate of complications in laparoscopy (4.25%) is similar to that of laparotomy (4.5%). The rate of rectovaginal fistula in case of rectal shaving is 8.3%, and in rectal segmental resection 3.1%, which is not associated with the distance between the anastomosis and the rectum. Voiding problems are frequent and the incidence of urinary retention ranges from 1 to 29% and depends on the interval of observation. Finally, in case of ureteral endometriosis, a double J catheter should be always placed in order to decrease the risk of ureteral fistula.
J Nassif
Lecture
7 years ago
1515 views
37 likes
0 comments
18:10
Complications of endometriosis surgery
This lecture focuses on complications in laparoscopic surgery for endometriosis. First, the expert addresses how to define complications. Surgeons sometimes need to remove part of the adjacent structures such as bowel, vagina and ureter, which should be included in the surgery – to achieve a complete excision of the disease. Complications can always occur and the most important thing to be borne in mind is to know how to deal with them by laparoscopy.
Complications may include adhesions, bowel, ureter and vascular injuries. The rate of complications in rectal shaving ranges from 0.2 to 1.4%. In case of discoid bowel resection, the morbidity rate published in the literature is 13%. Regarding rectal segmental resection, the rate of complications in laparoscopy (4.25%) is similar to that of laparotomy (4.5%). The rate of rectovaginal fistula in case of rectal shaving is 8.3%, and in rectal segmental resection 3.1%, which is not associated with the distance between the anastomosis and the rectum. Voiding problems are frequent and the incidence of urinary retention ranges from 1 to 29% and depends on the interval of observation. Finally, in case of ureteral endometriosis, a double J catheter should be always placed in order to decrease the risk of ureteral fistula.
Contemporary aspects on etiopathogenesis: strategies on diagnosis
This lecture addresses the etiopathogenesis of endometriosis, as defined by the presence of endometrial glands and stroma out of the uterine cavity. Endometriosis is present in 6-10% of women worldwide, 50-70% of women with pelvic pain and 30-50% of women with infertility. The main risk factors are early menarche, nulliparity and family history. Diagnosis frequently takes a long time from the onset of the first symptoms and constitutes a major healthcare problem in the United States. The most popular theory is retrograde menstruation, but other explanations are coelomic metaplasia, genetic predisposition, immune system dysfunction and environmental factors, which by means of inflammation, prostaglandin production and nerve regeneration could lead to pain and infertility. Endometriosis lesions have a known dependence with ovarian estrogens, but local conversion of androstenedione to estradiol inside the implants has been demonstrated, leading to proliferation of nerve fibers even after oophorectomy. Medical treatment aims to decrease inflammation, estrogen synthesis and local conversion of androgens to estrogens for a limited period of time. Surgical treatment aims to remove lesions and disrupt nerve production in the tissue, but there is a high percentage of symptom recurrence. Regarding infertility, endometriosis can cause adhesions affecting the ovary and the tube, but can also affect spermatozoa motility, migration of the embryo and prevent implantation, accounting for poor pregnancy outcomes in women with endometriosis.
To better visualize the expert's powerpoint presentation, please click here.
Ceana Nezhat
Lecture
7 years ago
2087 views
57 likes
1 comment
21:58
Contemporary aspects on etiopathogenesis: strategies on diagnosis
This lecture addresses the etiopathogenesis of endometriosis, as defined by the presence of endometrial glands and stroma out of the uterine cavity. Endometriosis is present in 6-10% of women worldwide, 50-70% of women with pelvic pain and 30-50% of women with infertility. The main risk factors are early menarche, nulliparity and family history. Diagnosis frequently takes a long time from the onset of the first symptoms and constitutes a major healthcare problem in the United States. The most popular theory is retrograde menstruation, but other explanations are coelomic metaplasia, genetic predisposition, immune system dysfunction and environmental factors, which by means of inflammation, prostaglandin production and nerve regeneration could lead to pain and infertility. Endometriosis lesions have a known dependence with ovarian estrogens, but local conversion of androstenedione to estradiol inside the implants has been demonstrated, leading to proliferation of nerve fibers even after oophorectomy. Medical treatment aims to decrease inflammation, estrogen synthesis and local conversion of androgens to estrogens for a limited period of time. Surgical treatment aims to remove lesions and disrupt nerve production in the tissue, but there is a high percentage of symptom recurrence. Regarding infertility, endometriosis can cause adhesions affecting the ovary and the tube, but can also affect spermatozoa motility, migration of the embryo and prevent implantation, accounting for poor pregnancy outcomes in women with endometriosis.
To better visualize the expert's powerpoint presentation, please click here.
Urinary complications during deep endometriosis surgery
During deep endometriosis surgery, bladder and ureter lesions are the most frequent complications.
Bladder lesions. The cystoscopy must be first carried out to assess the location of the endometriosis. If the nodule is close to the ureter, a stent is needed. To prevent lesion to the intramural part of the ureter, it is advisable to enter the bladder at its upper part. To minimize complications, an adequate surgical technique is necessary, a catheter must be placed for 1 to 3 weeks, a large catheter must be placed to drain clots, and control cystoscopy must be achieved before catheter removal. Intraoperative bladder lesions are never a major problem since the bladder wall heals well. Late complications are as follows: vesicovaginal fistula, rare but more frequent after hysterectomy, and the clinical sign is continuous leakage from the vagina, and the treatment is laparoscopy immediately or 50 days after surgery (with, in the last case, treatment with antibiotics until laparoscopic treatment begins). In addition, urinary retention is another late complication, more frequent, especially after resection of large nodules with lateral extension; it is due to parasympathetic nerve injury. Nerve-sparing prevention in endometriosis is not possible; the important thing is not to resect bilaterally. If injury is monolateral, it heals spontaneously in 3 months, rarely longer than 6-12 months.
Ureteral lesions. They occur mainly in cases of hydronephrosis or nodules bigger than 3 centimeters. In case of hydronephrosis, it is necessary to stent the patient before surgery; in all cases, especially when dealing with a nodule, the ureter should be isolated. After surgery a control cystoscopy must be carried out if the ureter works properly. It is important to monitor drain volume and CRP daily. CRP increases on the second day, and decreases on the third day. If CRP increases again, it means there is a complication (infection, ureteral lesion, leakage from rectum). Treatment is immediate laparoscopy with stitch and stent. Another complication is urinoma; symptoms are pain, diarrhea and high temperature. In these cases laparoscopy should be repeated. In case of ureterovaginal fistula, the leakage is intermittent. It usually becomes evident after 1 to 3 weeks. The diagnosis is made by intravenous pyelogram (IVP); treatment is carried out through laparoscopy. In case of unrecognized ureteral transection, there is a late ureteral leak (even after 25 days); ureteral re-anastomosis is the first-line treatment.
A Ussia
Lecture
7 years ago
908 views
17 likes
0 comments
17:28
Urinary complications during deep endometriosis surgery
During deep endometriosis surgery, bladder and ureter lesions are the most frequent complications.
Bladder lesions. The cystoscopy must be first carried out to assess the location of the endometriosis. If the nodule is close to the ureter, a stent is needed. To prevent lesion to the intramural part of the ureter, it is advisable to enter the bladder at its upper part. To minimize complications, an adequate surgical technique is necessary, a catheter must be placed for 1 to 3 weeks, a large catheter must be placed to drain clots, and control cystoscopy must be achieved before catheter removal. Intraoperative bladder lesions are never a major problem since the bladder wall heals well. Late complications are as follows: vesicovaginal fistula, rare but more frequent after hysterectomy, and the clinical sign is continuous leakage from the vagina, and the treatment is laparoscopy immediately or 50 days after surgery (with, in the last case, treatment with antibiotics until laparoscopic treatment begins). In addition, urinary retention is another late complication, more frequent, especially after resection of large nodules with lateral extension; it is due to parasympathetic nerve injury. Nerve-sparing prevention in endometriosis is not possible; the important thing is not to resect bilaterally. If injury is monolateral, it heals spontaneously in 3 months, rarely longer than 6-12 months.
Ureteral lesions. They occur mainly in cases of hydronephrosis or nodules bigger than 3 centimeters. In case of hydronephrosis, it is necessary to stent the patient before surgery; in all cases, especially when dealing with a nodule, the ureter should be isolated. After surgery a control cystoscopy must be carried out if the ureter works properly. It is important to monitor drain volume and CRP daily. CRP increases on the second day, and decreases on the third day. If CRP increases again, it means there is a complication (infection, ureteral lesion, leakage from rectum). Treatment is immediate laparoscopy with stitch and stent. Another complication is urinoma; symptoms are pain, diarrhea and high temperature. In these cases laparoscopy should be repeated. In case of ureterovaginal fistula, the leakage is intermittent. It usually becomes evident after 1 to 3 weeks. The diagnosis is made by intravenous pyelogram (IVP); treatment is carried out through laparoscopy. In case of unrecognized ureteral transection, there is a late ureteral leak (even after 25 days); ureteral re-anastomosis is the first-line treatment.
Surgical complications - it is possible to prevent them
Complications after laparoscopic surgery for endometriosis may occur even with a skilled surgeon and ideal circumstances. Success is linked to many factors, and not only to the surgeon’s experience. It is necessary to inform the patient in order to avoid medico-legal problems. An appropriate diagnosis must be performed, including clinical examination and all other necessary investigations. Proper instruments, anatomical knowledge, and exposure help to prevent severe complications. Make sure that you visualize the ureters at the beginning of the surgery as they always tend to go medially. In addition, ureterosacral resection should be avoided in order to prevent bladder dysfunction. Always prefer discoid excision of the bowel rather than bowel resection and make sure the suture does not exceed 3cm on the bowel, and avoid any vertical suturing when possible. If there is a history of surgery or a lesion near the ostia or a ureteral stenosis, ureteral stents should be placed. At the end of the procedure, it is recommended to carry out a blue dye or an air test, a cystoscopy or to place drains. A postoperative consultation is essential.
JM Wenger
Lecture
7 years ago
8866 views
444 likes
0 comments
24:53
Surgical complications - it is possible to prevent them
Complications after laparoscopic surgery for endometriosis may occur even with a skilled surgeon and ideal circumstances. Success is linked to many factors, and not only to the surgeon’s experience. It is necessary to inform the patient in order to avoid medico-legal problems. An appropriate diagnosis must be performed, including clinical examination and all other necessary investigations. Proper instruments, anatomical knowledge, and exposure help to prevent severe complications. Make sure that you visualize the ureters at the beginning of the surgery as they always tend to go medially. In addition, ureterosacral resection should be avoided in order to prevent bladder dysfunction. Always prefer discoid excision of the bowel rather than bowel resection and make sure the suture does not exceed 3cm on the bowel, and avoid any vertical suturing when possible. If there is a history of surgery or a lesion near the ostia or a ureteral stenosis, ureteral stents should be placed. At the end of the procedure, it is recommended to carry out a blue dye or an air test, a cystoscopy or to place drains. A postoperative consultation is essential.
Deep endometriosis excision with ureteral anastomosis followed by segmental rectosigmoid resection, transvaginal specimen extraction, and a transanal colorectal anastomosis
We present the case of a 29-year-old nulligest woman. Four years ago, she had a previous surgery with a rectovaginal nodule removed both by laparoscopy and vaginal approach. She has complained of dyspareunia (8/10), dysmenorrhea (8/10), dyschezia (8/10) and infertility over the last 2 years, but she also suffers from bladder dysfunction requiring urinary self-catheterization during her menstrual periods. The laparoscopic exploration revealed a big fibrotic nodule located in the right pelvic sidewall involving the right ureter and the rectum. Right ureter resection and anastomosis were performed. Segmental rectosigmoid resection was followed by transvaginal specimen extraction and a transanal colorectal anastomosis. The intracorporeal laparoscopic technique allows for a limited bowel devascularization and for an appropriate anastomosis with no need for extra abdominal incisions. No complications were noted and the patient had a good clinical evolution.
A Wattiez, J Leroy, E Faller, J Albornoz, P Messori
Surgical intervention
7 years ago
2541 views
21 likes
0 comments
30:14
Deep endometriosis excision with ureteral anastomosis followed by segmental rectosigmoid resection, transvaginal specimen extraction, and a transanal colorectal anastomosis
We present the case of a 29-year-old nulligest woman. Four years ago, she had a previous surgery with a rectovaginal nodule removed both by laparoscopy and vaginal approach. She has complained of dyspareunia (8/10), dysmenorrhea (8/10), dyschezia (8/10) and infertility over the last 2 years, but she also suffers from bladder dysfunction requiring urinary self-catheterization during her menstrual periods. The laparoscopic exploration revealed a big fibrotic nodule located in the right pelvic sidewall involving the right ureter and the rectum. Right ureter resection and anastomosis were performed. Segmental rectosigmoid resection was followed by transvaginal specimen extraction and a transanal colorectal anastomosis. The intracorporeal laparoscopic technique allows for a limited bowel devascularization and for an appropriate anastomosis with no need for extra abdominal incisions. No complications were noted and the patient had a good clinical evolution.
Laparoscopic management of endometriosis
This lecture reviews the surgical treatment of endometriosis from an evidence-based perspective focusing on outcomes such as pain and infertility in order to provide practical guidelines and recommendations.
The main endometriotic symptoms are pelvic pain (dysmenorrhea and dyspareunia) and infertility. Randomized controlled trials provide evidence that it is better to perform laparoscopy in patients with pain as compared to a wait and see approach. Regarding fertility, laparoscopic ablation or resection of lesions in minimal and mild endometriosis is significantly better than diagnostic laparoscopy alone. Laparoscopic uterosacral nerve ablation (LUNA) is not effective for relief of pain symptoms, but presacral neurectomy might be useful. In contrast, conservative surgery for rectovaginal septum endometriosis is beneficial for pain improvement, quality of life and sexual life, but do not improve fertility. Regarding radical surgery and bowel resection in endometriosis, there is a clear benefit in terms of pain improvement, but not on fertility. Regarding endometrial cyst treatment, excision is better than drainage in terms of risk of relapse, and the use of anti-adhesion barriers (Interceed®) have demonstrated a decreased risk of adhesion formation after endometriosis surgery.
Keys for surgical treatment of endometriosis should be identification of the disease, restoration of normal anatomy, excision of endometriosis, and finally reconstruction.
RP Pasic
Lecture
7 years ago
2015 views
27 likes
0 comments
44:23
Laparoscopic management of endometriosis
This lecture reviews the surgical treatment of endometriosis from an evidence-based perspective focusing on outcomes such as pain and infertility in order to provide practical guidelines and recommendations.
The main endometriotic symptoms are pelvic pain (dysmenorrhea and dyspareunia) and infertility. Randomized controlled trials provide evidence that it is better to perform laparoscopy in patients with pain as compared to a wait and see approach. Regarding fertility, laparoscopic ablation or resection of lesions in minimal and mild endometriosis is significantly better than diagnostic laparoscopy alone. Laparoscopic uterosacral nerve ablation (LUNA) is not effective for relief of pain symptoms, but presacral neurectomy might be useful. In contrast, conservative surgery for rectovaginal septum endometriosis is beneficial for pain improvement, quality of life and sexual life, but do not improve fertility. Regarding radical surgery and bowel resection in endometriosis, there is a clear benefit in terms of pain improvement, but not on fertility. Regarding endometrial cyst treatment, excision is better than drainage in terms of risk of relapse, and the use of anti-adhesion barriers (Interceed®) have demonstrated a decreased risk of adhesion formation after endometriosis surgery.
Keys for surgical treatment of endometriosis should be identification of the disease, restoration of normal anatomy, excision of endometriosis, and finally reconstruction.
Fully laparoscopic segmental rectosigmoid resection with Natural Orifice Specimen Extraction (NOSE) for bowel endometriosis
We report the case of a 45-year-old woman, G2P2, who presents with rectal bleeding, constipation and subocclusive syndrome caused by rectosigmoid endometriosis. The laparoscopic exploration revealed a sigmoid stuck by a few adhesions to the lateral abdominal wall underneath the left ovary and obliteration of the left uterosacral ligament and rectovaginal septum. A segmental bowel resection was performed with all necessary steps for mechanical bowel anastomosis carried out laparoscopically. The transvaginal specimen extraction obviated the need to create an abdominal incision. There were no complications and the patient presented a clinical remission following surgery. This surgical technique has the advantage of a shorter division of the mesentery, which enables a better vascularization of the bowel.
A Wattiez, J Leroy, S Maia, A Vázquez Rodriguez, P Trompoukis, J Alcocer
Surgical intervention
7 years ago
2369 views
10 likes
1 comment
08:03
Fully laparoscopic segmental rectosigmoid resection with Natural Orifice Specimen Extraction (NOSE) for bowel endometriosis
We report the case of a 45-year-old woman, G2P2, who presents with rectal bleeding, constipation and subocclusive syndrome caused by rectosigmoid endometriosis. The laparoscopic exploration revealed a sigmoid stuck by a few adhesions to the lateral abdominal wall underneath the left ovary and obliteration of the left uterosacral ligament and rectovaginal septum. A segmental bowel resection was performed with all necessary steps for mechanical bowel anastomosis carried out laparoscopically. The transvaginal specimen extraction obviated the need to create an abdominal incision. There were no complications and the patient presented a clinical remission following surgery. This surgical technique has the advantage of a shorter division of the mesentery, which enables a better vascularization of the bowel.
Laparoscopic partial cystectomy for deep endometriosis
Patients with bladder endometriosis may present with variable painful symptoms, hematuria, repeated urinary infection and/or infertility. The main treatment is a complete resection of the lesion. We report the case of a 30-year-old patient with no previous pregnancies presenting with pelvic endometriosis recurrence located at the level of the bladder dome. Her medical history shows a cystoscopic coagulation of an endometriotic nodule of the bladder. Preoperative MRI showed a 3cm single nodule protruding of the bladder. The procedure started by the dissection of the vesicouterine space followed by partial cystectomy using a monopolar hook. A running suture in two layers was carried out to close the cystotomy, and its integrity and bilateral ureteral patency was confirmed. Six weeks later at postoperative follow-up the patient was pain-free and without any urinary symptoms.
This video was awarded first place at the AAGL 5th International Congress on Minimally Invasive Gynecology held in conjunction with the Turkish Society of Gynecological Endoscopy (TSGE) 4th Annual Scientific Meeting.
A Wattiez, S Haddad, A Marot-Richter, A Vázquez Rodriguez, P Trompoukis, S Maia
Surgical intervention
8 years ago
2124 views
14 likes
0 comments
07:37
Laparoscopic partial cystectomy for deep endometriosis
Patients with bladder endometriosis may present with variable painful symptoms, hematuria, repeated urinary infection and/or infertility. The main treatment is a complete resection of the lesion. We report the case of a 30-year-old patient with no previous pregnancies presenting with pelvic endometriosis recurrence located at the level of the bladder dome. Her medical history shows a cystoscopic coagulation of an endometriotic nodule of the bladder. Preoperative MRI showed a 3cm single nodule protruding of the bladder. The procedure started by the dissection of the vesicouterine space followed by partial cystectomy using a monopolar hook. A running suture in two layers was carried out to close the cystotomy, and its integrity and bilateral ureteral patency was confirmed. Six weeks later at postoperative follow-up the patient was pain-free and without any urinary symptoms.
This video was awarded first place at the AAGL 5th International Congress on Minimally Invasive Gynecology held in conjunction with the Turkish Society of Gynecological Endoscopy (TSGE) 4th Annual Scientific Meeting.
Laparoscopic total hysterectomy and unilateral adnexectomy with resection of urinary bladder nodule for endometriosis
This video demonstrates the technique of a total laparoscopic hysterectomy with unilateral adnexectomy and the excision of a vesical endometriotic nodule.
This patient is a 46-year-old lady with a previous surgical history of one laparotomy for a hemoperitoneum (endometriotic ovarian cyst rupture) and 6 laparoscopies because of endometriosis, the last one 3 years ago with a segmental sigmoid resection. After this last surgery, the patient starts to complain of dysmenorrhea, chronic pelvic pain and dysuria. She has never had any urinary infection.
Because of urinary stress incontinence, she had botulinic toxin injection and underwent a cystoscopy, which revealed a bladder nodule.
A Wattiez, S Barata, AM Furtado Lima, P Trompoukis, B Gabriel, J Nassif
Surgical intervention
8 years ago
457 views
30 likes
1 comment
10:14
Laparoscopic total hysterectomy and unilateral adnexectomy with resection of urinary bladder nodule for endometriosis
This video demonstrates the technique of a total laparoscopic hysterectomy with unilateral adnexectomy and the excision of a vesical endometriotic nodule.
This patient is a 46-year-old lady with a previous surgical history of one laparotomy for a hemoperitoneum (endometriotic ovarian cyst rupture) and 6 laparoscopies because of endometriosis, the last one 3 years ago with a segmental sigmoid resection. After this last surgery, the patient starts to complain of dysmenorrhea, chronic pelvic pain and dysuria. She has never had any urinary infection.
Because of urinary stress incontinence, she had botulinic toxin injection and underwent a cystoscopy, which revealed a bladder nodule.
Laparoscopic ureteral anastomosis in a patient with hydronephrosis due to a severe endometriosis
Ureteral endometriosis is unfrequent and it is defined by the presence of endometrial glands in the ureteric or pre-ureteric tissue. The prevalence reported is less than 1% and usually confined to the lower one-third of the left ureter. This pathology generates a ureteral stenosis, with an extrinsic compression of the ureteral wall by the inflammatory response and fibrosis, or an intrinsic stenosis with the invasion of the uro-epithelium and submucosal layer of the ureteral wall. We present a short video describing the technique of the laparoscopic segmental ureteral resection followed by the re-anastomosis.
I Miranda-Mendoza, J Nassif, E Kovoor, A Wattiez
Surgical intervention
9 years ago
3474 views
9 likes
0 comments
07:57
Laparoscopic ureteral anastomosis in a patient with hydronephrosis due to a severe endometriosis
Ureteral endometriosis is unfrequent and it is defined by the presence of endometrial glands in the ureteric or pre-ureteric tissue. The prevalence reported is less than 1% and usually confined to the lower one-third of the left ureter. This pathology generates a ureteral stenosis, with an extrinsic compression of the ureteral wall by the inflammatory response and fibrosis, or an intrinsic stenosis with the invasion of the uro-epithelium and submucosal layer of the ureteral wall. We present a short video describing the technique of the laparoscopic segmental ureteral resection followed by the re-anastomosis.
Laparoscopic resection of deep endometriotic nodule for pelvic pain, left hydronephrosis and renal function impairment
Renal function impairment is a rare condition when associated with endometriosis. This video shows the laparoscopic resection of a deep endometriotic nodule for pelvic pain, left hydronephrosis and renal function impairment. The left kidney has an almost silent pattern on scintigraphy. The therapeutic strategy consists of freeing the obstacle caused by the endometriotic nodule, placement of a double J (JJ) catheter and monitoring for renal function in the postoperative follow-up. Further laparoscopic nephrectomy is to be discussed if the renal function is not improved.
A Wattiez, J Nassif, I Miranda-Mendoza, J Marescaux
Surgical intervention
10 years ago
2223 views
42 likes
0 comments
07:56
Laparoscopic resection of deep endometriotic nodule for pelvic pain, left hydronephrosis and renal function impairment
Renal function impairment is a rare condition when associated with endometriosis. This video shows the laparoscopic resection of a deep endometriotic nodule for pelvic pain, left hydronephrosis and renal function impairment. The left kidney has an almost silent pattern on scintigraphy. The therapeutic strategy consists of freeing the obstacle caused by the endometriotic nodule, placement of a double J (JJ) catheter and monitoring for renal function in the postoperative follow-up. Further laparoscopic nephrectomy is to be discussed if the renal function is not improved.