Posterior Compartment Peritonectomy: Technique Demonstration

Abstract

<h3>Study Objective</h3> Demonstrate the technique of in block peritonectomy excision of the posterior compartment of the pelvis for endometriosis treatment. <h3>Design</h3> Edited video of a surgery for endometriosis by the peritonectomy excision technique. <h3>Setting</h3> 3-port laparoscopy surgery. <h3>Patients or Participants</h3> Edited video of a usual case of deep infiltrating endometriosis in a 30-year-old patient. <h3>Interventions</h3> Deep infiltrative endometriosis (Grade IV by the AAGL classification), operated by the peritonectomy technique, with excision of the entire peritoneum of the posterior compartment and the connective tissue below, with shaving of a nodule from the rectum. <h3>Measurements and Main Results</h3> The procedure demonstrated in this edited video demonstrates a complete and satisfactory removal of endometriosis, with complete preservation of the ureters, blood vessels, hypogastric nerves, rectum, vagina, cervix and fasciae (Hypogastric and pre-sacral fasciae, more deeply). With complete release of the deep entrapment of somatic nerves. The patient in the exposed case had complete resolution of pain symptoms and spontaneous pregnancy 6 months after. <h3>Conclusion</h3> Endometriosis is a disease of superficial and deep infiltration of endometriotic tissue that spreads diffusely in the connective tissue of the pelvis. The ideal way of surgical removal of the disease is the in block resection of the entire affected compartment, a technique called by the authors as excision by peritonectomy. As shown in this video, it is a safe, effective and reproducible technique, only dependent on a deep knowledge of anatomy and the deep layers of the pelvis by the surgeon.