Nathan Mordel, M.D. »Janet Lefkowitz, D.O. »

Robotically Assisted Laparoscopic Excision and Endometriosis

Medical Background

Patient was a 28-year-old woman who had suffered from excruciating periods since age 12. Over time, in addition to her painfully heavy menstrual periods, she developed constant and at times debilitating pelvic pain that was only partially relieved by birth control pills. Sexual intercourse became unbearable and after a year of unsuccessful attempts to conceive she had undergone a laparoscopy by her OB/GYN. She was ultimately diagnosed with “frozen pelvis,” the most advanced stage of endometriosis in which the condition spreads throughout the pelvis and causes all pelvic organs (uterus, ovaries, tubes, rectum, bladder, ureters and bowels) to adhere to each other.

The OB/GYN chose not to attempt surgical excision on such challenging anatomy and placed the patient on a 6 month series of Lupron injections. Although there was improvement in endometriosis related symptoms, the side effects of the treatment included hot flushes, night sweats and mood swings.

Patient Results and Benefits of Minimally Invasive Robotically Assisted Laparoscopic Excision and Endometriosis

Not wanting to continue with Lupron, the patient turned to Atlanta Minimally Invasive Gynecological Surgical Center (AMIGS) where she opted for a Robotically Assisted Laparoscopic Excision and Endometriosis. The successful procedure resulted in complete removal of all visible endometriosis and restoration of the pelvic cavity. Patient returned home the same day and was able to resume her normal activities in 2 weeks. Three months later, the patient was pregnant.

Proper recognition and understanding of surgical anatomy is paramount to successful and safe completion of any surgery, including RALEE. Correct tissue handling and “prophylactic” hemostasis are equally important. These principles need to be followed regardless of the endometriosis excision route. Employment of Robotic and/or Laparoscopic instrumentation can’t “miraculously” replace or even enhance these principles.

“Frozen pelvis” is the most severe form of pelvic endometriosis. Conservative (uterine and adnexal preservation) RALEE requires careful and thorough retroperitoneal dissection, including complete ureterolysis, excision of endometrioma/s, rectosigmoid and bladder dissection. Placement of ureteral stents, consultation with robotically proficient urologist and colorectal surgeon may be required.

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