Intraoperative Ultrasound Elastography Guided Rectal Shaving for Endometriosis

Abstract

<h3>Study Objective</h3> Rectal surface endometriosis is more common in cases of cul-de-sac obstruction, and it is preferable in endometriosis surgery to remove as much of the deep endometriosis region as possible. The degree of rectal shaving may be confusing because the depth of the rectal superficial lesion cannot be assumed from the outside during surgery. For safe and appropriate resection, we attempted to confirm the location of the endometriosis lesion with intraoperative ultrasonography and elastography. <h3>Design</h3> Case report. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> A 23-years-old woman with dysmenorrhea diagnosed with left endometrioma and cul-de-sac obstruction by magnetic resonance imaging (MRI). <h3>Interventions</h3> Nerve-sparing endometriosis surgery including left ovarian cystectomy, cul-de-sac adhesiolysis, and deep endometriosis resection was planned. To evaluate the rectal surface endometriosis, a sterilized small ultrasound probe was inserted into the abdominal cavity through an abdominal trocar or small incision in the posterior vaginal fornix. Rectal surface fibrosis and the distance from the rectal muscularis were tried to be visualized with ultrasound elastography. <h3>Measurements and Main Results</h3> Intraoperative ultrasonography clearly indicated the safety distance from the rectal muscularis, and elastography showed hard fibrotic region on rectal surface with color visualization. There was no intra/post-operative complication. The pathological examination revealed the presence of endometriosis in the resected tissue. The visual analog scale (VAS) for dysmenorrhea was reduced from 70 to 10, and the VAS for dyspareunia was reduced from 50 to 0. <h3>Conclusion</h3> Intraoperative ultrasound elastography is considered to be a useful auxiliary means for safe rectal shaving by visualizing the fibrosis caused by endometriosis.