Stepwise approach to the laparoscopic excision of bladder endometriosis.

OBJECTIVE: To describe a stepwise approach to the laparoscopic excision of bladder endometriosis. DESIGN: Narrated surgical video. SETTING: Academic tertiary care hospital. PATIENT(S): Surgical footage was obtained from three patients who underwent surgery for bladder endometriosis. Institutional review board approval was not required in accordance with the Tri-Council Policy Statement of Canada, article 2.5. INTERVENTION(S): Laparoscopic excision of bladder endometriotic nodules by partial cystectomy. MAIN OUTCOME MEASURE(S): Overview of the relevant anatomy, disease overview, surgical planning and perioperative care, and the approach to the excision of bladder endometriotic nodules. RESULT(S): The approach to excision of bladder endometriotic nodules can be standardized in six reproducible steps: cystoscopy with or without ureteral stent placement; abdominal survey and treatment of posterior compartment disease; bladder mobilization; partial bladder cystectomy under cystoscopic guidance; cystotomy closure; and water-leak test. CONCLUSION(S): The safe and complete excision of bladder endometriosis relies on the understanding of surgical anatomy, the multidisciplinary aspect of patient care, and the standardization of the surgical approach.

Laparoscopic excision of pericardial and diaphragmatic endometriosis.

OBJECTIVE: To present a five-step approach to the laparoscopic excision of pericardial and diaphragmatic endometriosis. DESIGN: Surgical video. SETTING: Academic tertiary care hospital. PATIENT(S): 35-year-old nulliparous woman observed for chronic pelvic pain and infertility with a diagnosis of diaphragmatic endometriosis at a prior laparoscopy. Symptoms included severe chest pain and right shoulder tip pain, refractory to multiple medical therapies. INTERVENTION(S): Laparoscopic excision of pericardial and diaphragmatic endometriosis. MAIN OUTCOME MEASURE(S): Description of the relevant anatomy, the literature surrounding pericardial and diaphragmatic endometriosis, and the approach to the surgical intervention and postoperative care. RESULT(S): The laparoscopic excision of the full-thickness pericardial and diaphragmatic endometriotic lesions was successfully completed according to five reproducible steps: upper abdominal survey, liver mobilization, excision of diaphragmatic endometriosis, intrathoracic laparoscopic exploration, and closure of the diaphragmatic defect. CONCLUSION(S): Although rare and challenging to diagnose and treat, pericardial and diaphragmatic endometriosis and its potentially debilitating symptoms can be successfully managed through a multidisciplinary and stepwise surgical intervention.