Arnold Advincula's Surgical Techniques

Robot-assisted laparoscopic excision of a rectovaginal endometriotic nodule

A review of key anatomy and a stepwise demonstration of technique

Author and Disclosure Information

 

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.

Recommended Reading

Advanced techniques in cystectomy for mature cystic teratomas
MDedge ObGyn
Direct from San Antonio: SGS Fellow Scholar reports from society’s 2017 annual meeting
MDedge ObGyn
Delivering clinician should be seated
MDedge ObGyn
The role of moisturizers and lubricants in genitourinary syndrome of menopause and beyond
MDedge ObGyn
Abdominal myomectomy: Patient and surgical technique considerations
MDedge ObGyn
Don’t shy away from vaginal salpingectomy
MDedge ObGyn
Long-term durability low for nonmesh vaginal prolapse repair
MDedge ObGyn
Confirmatory blood typing unnecessary for closed prolapse repairs
MDedge ObGyn
Predicting extraction of an intact uterus in robotic-assisted laparoscopic hysterectomy
MDedge ObGyn
Lightweight mesh reduces erosion risk after sacrocolpopexy
MDedge ObGyn