RESUMEN
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.
Asunto(s)
Cistoscopía/métodos , Endometriosis/cirugía , Laparoscopía/métodos , Enfermedades de la Vejiga Urinaria/cirugía , Adulto , Canadá , Cistectomía/métodos , Femenino , Procedimientos Quirúrgicos Ginecológicos/métodos , HumanosRESUMEN
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.