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Techniques in minimally invasive surgery for advanced endometriosis

King, Cara R.; Lum, Deirdre

Current Opinion in Obstetrics and Gynecology: August 2016 - Volume 28 - Issue 4 - p 316–322
doi: 10.1097/GCO.0000000000000291
MINIMALLY INVASIVE GYNECOLOGIC PROCEDURES: Edited by Matthew T. Siedhoff

Purpose of review Surgery can be an important treatment option for women with symptomatic endometriosis. This review summarizes the recommended preoperative work up and techniques in minimally invasive surgery for treatment of deeply infiltrating endometriosis (DIE) involving the obliterated posterior cul-de-sac, bowel, urinary tract, and extrapelvic locations.

Recent findings Surgical management of DIE can pose a challenge to the gynecologic surgeon given that an extensive dissection is usually necessary. Given the high risk of recurrence, it is vital that an adequate excision is performed. With improved imaging modalities, preoperative counseling and surgical planning can be optimized. It is essential to execute meticulous surgical technique and include a multidisciplinary surgical team when indicated for optimal results.

Summary Advanced laparoscopic skills are often necessary to completely excise DIE. A thorough preoperative work up is essential to provide correct patient counseling and incorporation of the preferred surgical team to decrease complications and optimize surgical outcomes. Surgical management of endometriosis is aimed at ameliorating symptoms and preventing recurrence.

aUniversity of Wisconsin-Madison, Madison, Wisconsin

bStanford University, Stanford, California, USA

Correspondence to Cara R. King, DO, MS, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA. Tel: +413 535 8220; e-mail: Cking8@wisc.edu

Copyright © 2016 YEAR Wolters Kluwer Health, Inc. All rights reserved.