Frozen Pelvis

Abstract

Study Objective To demonstrate that a pelvis is never really frozen in a case of a deep infiltrative endometriosis. Design Surgical video of a pelvis completed affected by deep endometriosis with significant anatomical distortion. Setting We describe a case of a 37 years-old woman referred to our center complaining of severe dysmenorrhea, dyspareunia and chronic pelvic pain. The patient had no relevant past medical. The pre-operative investigation involved a transvaginal magnetic resonance imaging that showed an infiltrative endometriotic nodule on the paracervix and posterior vaginal fornix, with involvement of the left ovary and a retossigmoid nodule with 4cm of diameter and 8cm from de anal verge. The patient was in clinical treatment with dienogest, without response. We scheduled a surgical procedure for radical eradication of the deep infiltrating endometriosis. Patients or Participants One patient with a pelvis completed affected by deep endometriosis with significant anatomical distortion. Interventions A step-by-step surgical video, demonstrating a systematic approach in case of deep infiltrating endometriosis, indicating surgical landmarks and a proper technique. It emphasizes mainly the development of the avascular spaces, isolation of the ureteral course, identification of the parametrial ligaments, preservation of the cranial, middle and caudal parts of the hypogastric plexus, performance of retossigmoid resection. Measurements and Main Results full and complete excision of all endometriosis lesions and restore of the anatomy. Conclusion The main indication for surgical treatment in women with endometriosis is pain and impairment in quality of life and the radical eradication of deep endometriosis is related not only with the relieve of symptoms, but also with the minimization of recurrences. The nerve-sparing technique is considered a feasible, safety and reliability approach and clearly is associated with lower post-operative complication rate and better results in terms of debilitating impairments in neurological functions. To demonstrate that a pelvis is never really frozen in a case of a deep infiltrative endometriosis. Surgical video of a pelvis completed affected by deep endometriosis with significant anatomical distortion. We describe a case of a 37 years-old woman referred to our center complaining of severe dysmenorrhea, dyspareunia and chronic pelvic pain. The patient had no relevant past medical. The pre-operative investigation involved a transvaginal magnetic resonance imaging that showed an infiltrative endometriotic nodule on the paracervix and posterior vaginal fornix, with involvement of the left ovary and a retossigmoid nodule with 4cm of diameter and 8cm from de anal verge. The patient was in clinical treatment with dienogest, without response. We scheduled a surgical procedure for radical eradication of the deep infiltrating endometriosis. One patient with a pelvis completed affected by deep endometriosis with significant anatomical distortion. A step-by-step surgical video, demonstrating a systematic approach in case of deep infiltrating endometriosis, indicating surgical landmarks and a proper technique. It emphasizes mainly the development of the avascular spaces, isolation of the ureteral course, identification of the parametrial ligaments, preservation of the cranial, middle and caudal parts of the hypogastric plexus, performance of retossigmoid resection. full and complete excision of all endometriosis lesions and restore of the anatomy. The main indication for surgical treatment in women with endometriosis is pain and impairment in quality of life and the radical eradication of deep endometriosis is related not only with the relieve of symptoms, but also with the minimization of recurrences. The nerve-sparing technique is considered a feasible, safety and reliability approach and clearly is associated with lower post-operative complication rate and better results in terms of debilitating impairments in neurological functions.