Simplifying Conservative Surgical Techniques for Resection of Endometriosis for Non-Endometriosis Surgeons

INTRODUCTION: Prior studies have noted improved pregnancy rates (both spontaneous and resulting from assisted reproductive technologies (ART)) of up to 53–70% following conservative surgical excision of endometriosis in patients with deep endometriosis, as well as up to 1.8 times higher pregnancy odds if surgery is performed before starting in vitro fertilization (IVF) treatments. OBJECTIVE: To simplify surgical techniques for conservative resection of endometriosis for non-endometriosis surgeons. METHODS: Robotic-assisted laparoscopic excision of endometriosis is shown for three patients with stage III/IV disease as graded by the AAGL 2021 Endometriosis Classification system. All patients desired future fertility; hence, conservative excision techniques were performed including preservation of the uterus, ovaries, restoration of normal anatomy, and removal of endometriotic lesions. Specifically, the video demonstrates the steps in performing an ovarian cystectomy of a 9-cm endometrioma, dissection and excision of an obliterated posterior cul-de-sac, ureterolysis, resection of ovarian fossa lesions, and resection of bowel lesions including appendectomy and ileo-cecal bowel resection with re-anastomosis. RESULTS: This video displays key techniques for excision of endometriosis in patients with different stages of endometriosis who desire fertility preservation. CONCLUSIONS: These surgical techniques can be used in a wide variety of patients with advanced stage endometriosis for safe and successful resection, improving not only patient symptoms but possibly reproductive function and ART outcomes as well.