Abstract
<h3>Study Objective</h3> to assess the feasibility, benefits, ease of doing and repetitiveness of all 7 steps designed. <h3>Design</h3> this study was a prospective study. <h3>Setting</h3> patient laid in dorsal lithotomy position with reverse Trendelenburg position. <h3>Patients or Participants</h3> we had selected 10 patients diagnosed with endometriosis. TVS is chosen as a preferred diagnostic tool. <h3>Interventions</h3> fixed 7 steps followed in all cases. 1. <b>Mobilisation of sigmoid colon</b>- adhesions of sigmoid colon with lateral pelvic wall were released. 2. <b>identifying the left ureter</b>- open the retroperitoneum near to the ureter, identify & follow it till it enters into the tunnel. 3. <b>Dissection into the left pararectal space</b>- dissect into the left pararectal space till the base of uterosacral ligament [USL]. Identify the hypogastric nerve here. 4. <b>identifying the right ureter –</b> same as step 2. 5. <b>Dissection into the right pararectal space –</b> same as step 3. 6. <b>Dissection of rectum into POD –</b> pull the rectum cranially and dissect between the two layers of Denonvilliers fascia into the POD. 7. <b>Excision of endometriotic nodules or cyst-</b> take out any nodules present with involved peritoneum. <h3>Measurements and Main Results</h3> in this study, all patients operated with success without any injury to any vital structure, taking out all endometriotic tissue with increasing ease of doing consequently. average operating time was 130.6minutes and average blood was 100.5ml. patient allowed orally after 6 to 12 hours of surgery, average stay in post-operative period was 36 hours. <h3>Conclusion</h3> if we follow these 7 steps properly during surgery, we can definitely avoid unintended injury to ureter and rectum, fellow colleagues can learn the technique easily and reproducible nature of these steps make it more operator friendly. Further studies needed to be followed by masses.
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