Case reports (part 1) of spontaneous pregnancies following DIE excision
by Alysson Zanatta

Comprehensive Video Atlas of Laparoscopic Surgery in Infertility and Gynecology

by Nutan Jain
About Video

This video includes two parts. The first part of this video demonstrates 36-years-old female patient present complaints with primary infertility for 2 years, dysmenorrhea and chronic pelvic pain since 1 year. Sonography: Deep endometriosis: lesions in the posterior pelvis, including a 2 cm nodule in the rectosigmoid. Presumptive diagnosis: deep infiltrating endometriosis. In this video showing four ports laparoscopy under general and regional anesthesia in modified lithotomy position, all the ports are 5 mm except camera port which is 10 mm. Deep endometriosis was identified in the posterior pelvis, leading to a complete cul-de-sac obliteration. The lesion was contiguous to a 2 cm nodule in the rectosigmoid. It is inferior limit situated about 13 cm proximal to the anal border. Besides superficial endometriosis in the left ovary, both adnexa looked normal, and tubes were patent to saline with methylene-blue. Both ureters were identified at the level of the pelvic brim, and bilateral ureterolysis was done down to the ureteral tunnels. The uterus and ovaries were suspended with prolene sutures, for better exposure of the posterior pelvis. These sutures were removed after 7 days, to reduce postoperative adhesions. Extensive resection of all endometriotic lesions was done, including partial colpectomy and discoid resection of the rectosigmoid with a circular stapler passed per anus. Postoperative period was marked by transient urinary dysfunction treated with physical therapy. The second part of this video demonstrates 30-years-old female patients present complaints with primary infertility for 10 years, dysmenorrhea and chronic pelvic pain for 8 years. Presumptive diagnosis: deep endometriosis. This video illustrates four ports laparoscopy under general and regional anesthesia in modified lithotomy position. Deep endometriosis was identified in the posterior pelvis, leading to a complete cul-de-sac obliteration. Rectosigmoid was irregular and blocking the pelvis, containing nodules distributed in a segment of about 12 cm. Left adnexa was completely distorted, and right tube was congested because of inflammatory reaction around it. Both ureters were identified at the level of the pelvic brim, and bilateral ureterolysis was done down to the ureteral tunnels. The uterus was suspended with prolene suture, for better exposure of the posterior pelvis. Right cystectomy was done by meticulous draining of endometriomas, without excising pseudocapsule, because of anticipated possibility of premature ovarian failure. Sutures for temporary hysteropexy and oophoropexy were removed after 7 days, to reduce postoperative adhesions. Left adnexectomy was necessary because of advanced disease. Extensive resection of all endometriotic lesions was done, including right salpingolysis, partial colpectomy and segmental resection of the rectosigmoid. Postoperative period was marked by transient urinary dysfunction and treated with physiotherapy. Patient got pregnant spontaneously 3 months after surgery. Delivery is expected in three months.

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