Home > Gynecology, Surgery, Surgical Videos > Surgical Video: Deep Infiltrating Endometriosis Resection #1

Surgical Video: Deep Infiltrating Endometriosis Resection #1

This video demonstrates techniques for resecting infiltrating endometriosis, including dissection of bilateral ureters and pararectal spaces.

 

For consultation with Dr Fogelson please call Emory University at (404) 778-4416
Copyright 2012 Nicholas Fogelson and http://www.academicobgyn.com

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  1. Dr Jasmine Mohd, Minimally Invasive Surgery Unit, KK Women’s and Children’s Hospital, Singapore
    October 9, 2012 at 4:18 am | #1

    Thank you for the video. It seems however that the cystectomy was not performed, I am not certain if you left that part out in your video clip. After the incision into the cyst was made with scissors and the fluid drained out, there was a very clear plane between the cyst wall and ovary through which you could have stripped the cyst wall off. That was a large cyst, and very likely will recur quickly if the cyst wall was not stripped off. i like using a pair of fine grasping forceps with teeth to separate the cyst wall from the ovary. the initial identification of the plane is the hardest, but subsequently gets very easy during the rest of the stripping process. This cyst also looks like its been there a while, those cystectomies are moderately easier as the cyst wall is thicker. This is in comparison to new endometriotic cysts, in which the cyst wall is so friable that it comes off in pieces.

    • October 9, 2012 at 6:10 am | #2

      Thank you for your comments. We resected most of the cyst capsule, but there was not a clear plane that was easily identifiable. Hopefully there will not be recurrence.

      I think that there may indeed be two different origins for endometriomas, that lead to different types of capsules. I have seen some that seem to have originated as hemorraghic cysts and therefore have a clear cystic capsule. I have seen others that seem to have a much less organized capsule, presumably originating through invagination of an implant originating on the surface of the ovary.

      I have found that complete resection is quite a bit easier using robotic laparoscopy.

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