Laparoscopic Excision of Parametrium Endometriosis

Abstract

<h3>Study Objective</h3> To present a case of parametrium and bladder endometriosis. <h3>Design</h3> Case report illustrated with video. <h3>Setting</h3> Patient placed in semi-gynecological position, legs in stirrups and Trendelenburg tilt. A minimally invasive laparoscopic surgery was performed helped by a uterine manipulator. <h3>Patients or Participants</h3> We present the case of a 29-year-old woman complaining of chronic pelvic pain, severe dysmenorrhea radiating to lumbar region and coccyx, and intense deep dyspareunia. At the pelvic examination, she had a 4 cm painful nodule affecting the left parametrium, extending to the paravaginal aspect and ipsilateral uterosacral ligament. The complementary investigation with pelvic ultrasound evidenced a uterus with 83cc volume, a 1.5cm leiomyoma, a 1cm infiltrating vesical nodule, a 2 cm nodule in the right round ligament, and a 4 cm retrocervical nodule affecting left parametrium and vaginal wall. <h3>Interventions</h3> Laparoscopic surgical removal of all endometriotic lesions. <h3>Measurements and Main Results</h3> Patient was discharged in the 1^st post-operative day and maintained the use of foley catheter up to the 14th day. She had a negative post-void residual test, no urinary impairment and complete remission of symptoms. The final pathological report confirmed endometriosis and leiomyoma. <h3>Conclusion</h3> Parametrium endometriosis can affect around 17% of women with deep endometriosis, and the surgical treatment can cause voiding disfunctions due to inferior hypogastric nerve and plexus proximity. We should always perform a nerve-sparing surgery when possible.