Robot-assisted laparoscopic excision of a rectovaginal endometriotic nodule

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Robot-assisted laparoscopic excision of a rectovaginal endometriotic nodule
A review of key anatomy and a stepwise demonstration of technique

A rectovaginal endometriosis (RVE) is the most severe form of endometriosis. The gold standard for diagnosis is laparoscopy with histologic confirmation. A review of the literature suggests that surgery improves up to 70% of symptoms with generally favorable outcomes.

In this video, we provide a general introduction to endometriosis and a discussion of disease treatment options, ranging from hormonal suppression to radical bowel resections. We also illustrate the steps in robot-assisted laparoscopic excision of an RVE nodule:

  1. identify the borders of the rectosigmoid
  2. dissect the pararectal spaces  
  3. release the rectosigmoid from its attachment to the RVE nodule
  4. identify and isolate the ureter(s)
  5. determine the margins of the nodule  
  6. ensure complete resection.

Excision of an RVE nodule is a technically challenging surgical procedure. Use of the robot for resection is safe and feasible when performed by a trained and experienced surgeon.

I am pleased to bring you this video, and I hope that it is helpful to your practice. 

>> Arnold P. Advincula, MD

 

 

Vidyard Video

 

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

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Dr. Madueke-Laveaux is Assistant Attending, Department of Obstetrics & Gynecology, Columbia University Medical Center, New York, New York.

Dr. Simpson is Assistant Professor, Minimally Invasive Gynecology, Johns Hopkins Hospital, Baltimore, Maryland.

Dr. Advincula is the Levine Family Professor of Women’s Health and Vice Chair, Department of Obstetrics & Gynecology, Columbia University Medical Center and Chief of Gynecology, Sloane Hospital for Women at New York-Presbyterian Hospital/Columbia University. He serves on the OBG Management Board of Editors.

Dr. Advincula reports being a consultant to Intuitive Surgical and Titan Medical and having additional financial relationships with Applied Medical, ConMed, and CooperSurgical. The other authors report no relevant financial relationships relevant to this video.

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Dr. Madueke-Laveaux is Assistant Attending, Department of Obstetrics & Gynecology, Columbia University Medical Center, New York, New York.

Dr. Simpson is Assistant Professor, Minimally Invasive Gynecology, Johns Hopkins Hospital, Baltimore, Maryland.

Dr. Advincula is the Levine Family Professor of Women’s Health and Vice Chair, Department of Obstetrics & Gynecology, Columbia University Medical Center and Chief of Gynecology, Sloane Hospital for Women at New York-Presbyterian Hospital/Columbia University. He serves on the OBG Management Board of Editors.

Dr. Advincula reports being a consultant to Intuitive Surgical and Titan Medical and having additional financial relationships with Applied Medical, ConMed, and CooperSurgical. The other authors report no relevant financial relationships relevant to this video.

Author and Disclosure Information

Dr. Madueke-Laveaux is Assistant Attending, Department of Obstetrics & Gynecology, Columbia University Medical Center, New York, New York.

Dr. Simpson is Assistant Professor, Minimally Invasive Gynecology, Johns Hopkins Hospital, Baltimore, Maryland.

Dr. Advincula is the Levine Family Professor of Women’s Health and Vice Chair, Department of Obstetrics & Gynecology, Columbia University Medical Center and Chief of Gynecology, Sloane Hospital for Women at New York-Presbyterian Hospital/Columbia University. He serves on the OBG Management Board of Editors.

Dr. Advincula reports being a consultant to Intuitive Surgical and Titan Medical and having additional financial relationships with Applied Medical, ConMed, and CooperSurgical. The other authors report no relevant financial relationships relevant to this video.

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A review of key anatomy and a stepwise demonstration of technique
A review of key anatomy and a stepwise demonstration of technique

A rectovaginal endometriosis (RVE) is the most severe form of endometriosis. The gold standard for diagnosis is laparoscopy with histologic confirmation. A review of the literature suggests that surgery improves up to 70% of symptoms with generally favorable outcomes.

In this video, we provide a general introduction to endometriosis and a discussion of disease treatment options, ranging from hormonal suppression to radical bowel resections. We also illustrate the steps in robot-assisted laparoscopic excision of an RVE nodule:

  1. identify the borders of the rectosigmoid
  2. dissect the pararectal spaces  
  3. release the rectosigmoid from its attachment to the RVE nodule
  4. identify and isolate the ureter(s)
  5. determine the margins of the nodule  
  6. ensure complete resection.

Excision of an RVE nodule is a technically challenging surgical procedure. Use of the robot for resection is safe and feasible when performed by a trained and experienced surgeon.

I am pleased to bring you this video, and I hope that it is helpful to your practice. 

>> Arnold P. Advincula, MD

 

 

Vidyard Video

 

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

A rectovaginal endometriosis (RVE) is the most severe form of endometriosis. The gold standard for diagnosis is laparoscopy with histologic confirmation. A review of the literature suggests that surgery improves up to 70% of symptoms with generally favorable outcomes.

In this video, we provide a general introduction to endometriosis and a discussion of disease treatment options, ranging from hormonal suppression to radical bowel resections. We also illustrate the steps in robot-assisted laparoscopic excision of an RVE nodule:

  1. identify the borders of the rectosigmoid
  2. dissect the pararectal spaces  
  3. release the rectosigmoid from its attachment to the RVE nodule
  4. identify and isolate the ureter(s)
  5. determine the margins of the nodule  
  6. ensure complete resection.

Excision of an RVE nodule is a technically challenging surgical procedure. Use of the robot for resection is safe and feasible when performed by a trained and experienced surgeon.

I am pleased to bring you this video, and I hope that it is helpful to your practice. 

>> Arnold P. Advincula, MD

 

 

Vidyard Video

 

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

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Robot-assisted laparoscopic excision of a rectovaginal endometriotic nodule
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Robot-assisted laparoscopic resection of a noncommunicating cavitary rudimentary horn

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Robot-assisted laparoscopic resection of a noncommunicating cavitary rudimentary horn
Robotic surgery is a safe and feasible option for managing this mullerian duct anomaly

A unicornuate uterus with a noncommunicating rudimentary horn is a rare mullerian duct anomaly (MDA). It often goes undiagnosed due to the absence of functional endometrium in the anomalous horn. However, when the rudimentary horn is lined with endometrium, obstructed menstrual flow can lead to severe cyclic pelvic pain, development of a pelvic mass, and endometriosis from retrograde menstruation. For these reasons, surgical resection is recommended for patients with this anomaly.

In this video the surgical patient is a 15-year-old adolescent with a 1-year history of progressive dysmenorrhea. Imaging studies revealed a noncommunicating cavitary right uterine horn and confirmed a normal urinary tract system.

We present a stepwise demonstration of our technique for surgical resection of a noncommunicating cavitary uterine horn and conclude that robotic surgery is a safe and feasible route for surgical management of this pathology.

I am pleased to bring you this video to kick off the New Year. We are delighted that our work won "Best Video on Robotic Technology" at the annual AAGL meeting in November 2016, and I hope that it is helpful to your practice.

 

Vidyard Video

 

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

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Dr. Madueke-Laveaux is Minimally Invasive Gynecology Fellow/Assistant Attending at Columbia University Medical Center, New York, New York.

Dr. Rackow is Director, Pediatric and Adolescent Gynecology Program in the Departments of Reproductive Endocrinology & Infertility and Gynecologic Surgery at Columbia University Medical Center.

Dr. Advincula is the Levine Family Professor of Women’s Health and Vice Chair, Department of Obstetrics & Gynecology, Columbia University Medical Center and Chief of Gynecology, Sloane Hospital for Women at New York-Presbyterian Hospital/Columbia University. He serves on the OBG Management Board of Editors.

Dr. Advincula reports being a consultant to Intuitive Surgical and Titan Medical and having additional financial relationships with Applied Medical, ConMed, and CopperSurgical. The other authors report no relevant financial relationships relevant to this video.

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Dr. Madueke-Laveaux is Minimally Invasive Gynecology Fellow/Assistant Attending at Columbia University Medical Center, New York, New York.

Dr. Rackow is Director, Pediatric and Adolescent Gynecology Program in the Departments of Reproductive Endocrinology & Infertility and Gynecologic Surgery at Columbia University Medical Center.

Dr. Advincula is the Levine Family Professor of Women’s Health and Vice Chair, Department of Obstetrics & Gynecology, Columbia University Medical Center and Chief of Gynecology, Sloane Hospital for Women at New York-Presbyterian Hospital/Columbia University. He serves on the OBG Management Board of Editors.

Dr. Advincula reports being a consultant to Intuitive Surgical and Titan Medical and having additional financial relationships with Applied Medical, ConMed, and CopperSurgical. The other authors report no relevant financial relationships relevant to this video.

Author and Disclosure Information

Dr. Madueke-Laveaux is Minimally Invasive Gynecology Fellow/Assistant Attending at Columbia University Medical Center, New York, New York.

Dr. Rackow is Director, Pediatric and Adolescent Gynecology Program in the Departments of Reproductive Endocrinology & Infertility and Gynecologic Surgery at Columbia University Medical Center.

Dr. Advincula is the Levine Family Professor of Women’s Health and Vice Chair, Department of Obstetrics & Gynecology, Columbia University Medical Center and Chief of Gynecology, Sloane Hospital for Women at New York-Presbyterian Hospital/Columbia University. He serves on the OBG Management Board of Editors.

Dr. Advincula reports being a consultant to Intuitive Surgical and Titan Medical and having additional financial relationships with Applied Medical, ConMed, and CopperSurgical. The other authors report no relevant financial relationships relevant to this video.

Article PDF
Article PDF
Robotic surgery is a safe and feasible option for managing this mullerian duct anomaly
Robotic surgery is a safe and feasible option for managing this mullerian duct anomaly

A unicornuate uterus with a noncommunicating rudimentary horn is a rare mullerian duct anomaly (MDA). It often goes undiagnosed due to the absence of functional endometrium in the anomalous horn. However, when the rudimentary horn is lined with endometrium, obstructed menstrual flow can lead to severe cyclic pelvic pain, development of a pelvic mass, and endometriosis from retrograde menstruation. For these reasons, surgical resection is recommended for patients with this anomaly.

In this video the surgical patient is a 15-year-old adolescent with a 1-year history of progressive dysmenorrhea. Imaging studies revealed a noncommunicating cavitary right uterine horn and confirmed a normal urinary tract system.

We present a stepwise demonstration of our technique for surgical resection of a noncommunicating cavitary uterine horn and conclude that robotic surgery is a safe and feasible route for surgical management of this pathology.

I am pleased to bring you this video to kick off the New Year. We are delighted that our work won "Best Video on Robotic Technology" at the annual AAGL meeting in November 2016, and I hope that it is helpful to your practice.

 

Vidyard Video

 

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

A unicornuate uterus with a noncommunicating rudimentary horn is a rare mullerian duct anomaly (MDA). It often goes undiagnosed due to the absence of functional endometrium in the anomalous horn. However, when the rudimentary horn is lined with endometrium, obstructed menstrual flow can lead to severe cyclic pelvic pain, development of a pelvic mass, and endometriosis from retrograde menstruation. For these reasons, surgical resection is recommended for patients with this anomaly.

In this video the surgical patient is a 15-year-old adolescent with a 1-year history of progressive dysmenorrhea. Imaging studies revealed a noncommunicating cavitary right uterine horn and confirmed a normal urinary tract system.

We present a stepwise demonstration of our technique for surgical resection of a noncommunicating cavitary uterine horn and conclude that robotic surgery is a safe and feasible route for surgical management of this pathology.

I am pleased to bring you this video to kick off the New Year. We are delighted that our work won "Best Video on Robotic Technology" at the annual AAGL meeting in November 2016, and I hope that it is helpful to your practice.

 

Vidyard Video

 

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

Issue
OBG Management - 29(1)
Issue
OBG Management - 29(1)
Page Number
51
Page Number
51
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Robot-assisted laparoscopic resection of a noncommunicating cavitary rudimentary horn
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Robot-assisted laparoscopic resection of a noncommunicating cavitary rudimentary horn
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