Arnold Advincula's Surgical Techniques

Robot-assisted laparoscopic excision of a rectovaginal endometriotic nodule

A review of key anatomy and a stepwise demonstration of technique

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A rectovaginal endometriosis (RVE) is the most severe form of endometriosis. The gold standard for diagnosis is laparoscopy with histologic confirmation. A review of the literature suggests that surgery improves up to 70% of symptoms with generally favorable outcomes.

In this video, we provide a general introduction to endometriosis and a discussion of disease treatment options, ranging from hormonal suppression to radical bowel resections. We also illustrate the steps in robot-assisted laparoscopic excision of an RVE nodule:

  1. identify the borders of the rectosigmoid
  2. dissect the pararectal spaces
  3. release the rectosigmoid from its attachment to the RVE nodule
  4. identify and isolate the ureter(s)
  5. determine the margins of the nodule
  6. ensure complete resection.

Excision of an RVE nodule is a technically challenging surgical procedure. Use of the robot for resection is safe and feasible when performed by a trained and experienced surgeon.

I am pleased to bring you this video, and I hope that it is helpful to your practice.

>> Arnold P. Advincula, MD

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