Pelvic sidewall dissection for deep infiltrated endometriosis
The purpose of endometriosis surgery is to remove all the disease.
Operative findings
The patient underwent laparoscopy because of dysmenorrhea and chronic pelvic pain (lumbago and left leg pain)
Left ovarian endometrioma (6cm) was attached to the pelvic sidewall and the rectum was converged on left uterosacral ligament. (re-ASRM 50)
Lysis of left ovary and pelvic sidewall
Deep lesion was found on the peritoneal surface of ovarian fossa.
After identifing left ureter from the pelvic inlet, endometriosis was excised.
Pelvic lesion was excised after separating from left ureter.
Endometriosis around umblical ligament, uterine artery and ureter was excised.
Endometriosis around uterine artery and ureter was excised.
Endometriosis on the uterosacral ligament and the rectom has not excised at this point.
Excision of endometriosis at the rectal surface.
Endometriosis on the rectal surface is excised by needle tip monopolar. Care should be taken not to injure left middle rectal artery.
Suturing rectal surface
The defect of rectal surface was repaired with 3-0PDS2.
End of the surgery
The surgery has finished after ovarian cystectomy
Operating time 240 minutes
Blood loss 50g
The patient had no menstrual pain and chronic pelvic pain and got pregnant three months after the surgery.
Pelvic sidewall dissectioon for endometriosis
Ovarian endometrioma and pelvic adhesion can be the origin of dysmenorrhea and chronic pelvic pain. Wide excision of endometriosis is necessary to cure pelvic pain.
