Deep Endometriosis
24 year old patient, nullipara who desires to obtain pregnancy after the surgical treatment of endometriosus.
The patient preseent intense dyspareunia and dysmenorea (VAS=8) TV ultrasound reveals bilateral endometriotic cysts Surgery: Robotic cystectomy, excision of left parametrial deep endometriosis lesions Robotic cystectomy – the excision of the endometriotic cyst can be easily performed with the robot without affecting the ovarian structure.
Even in the adherent areas around the ovarian hilum dissection is easily done without stripping healthy ovarian tissue.
A difficult case recently successfully performed by Endomedicare Academy team: a young woman of age 27 with deep endometriosis infiltrating both parametrium, the rectum and the right ureter.
The case was surgically managed using the robotic DaVinci XI platform.
A complete preoperative imagistic diagnosis was necessary for assessing the need of a multidisciplinary team. Both transvaginal ultrasound and MRI showed bilateral ovarian endometriomas, parametrial left and right nodule, deep infiltrating endometriotic nodule of the rectum of around 2,5.
Kidney ultrasound showed hydronephrosis grade 3 on the right side. The robotic platform was used by mutidisciplinary surgical specialties including gynecology, colorectal, and urology to ensure complete resection of endometriosis lesions involving multiple organs.
The bilateral parametrial deep infiltrating endometriotic nodules excision, rectosigmoidianresection with end to end anastomosis and ureteral reimplantation were performed completely using da Vinci XI robot.
⇒ No ileostomy;
⇒ Fast recovery. After 4 days, our patient left the hospital in a very good shape.
Ask for information about the robotic intervention
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Interventions
Endometriosis surgery
With a remarkable expertise of over 15 years in gynecological surgery, focusing on minimally invasive endometriosis surgery.
Our team, led by Prof. Dr. Elvira Bratila, has successfully performed over 450 interventions of complex forms of deep endometriosis – deep bladder, ureteral endometriosis, endometriosis with multiple intestinal locations -helping hundreds of patients regain their health and quality of life in a disease that invalidates the patients through pain, infertility and psychological impact.
Uterine fibroid is the most common benign tumor that develops in the muscular layer of the uterus. The onset and development of uterine fibroids occurs during a woman’s reproductive period, with significantly elevated hormone levels during this period contributing to their growth.
Approximately 40% of women over the age of 35 are diagnosed with uterine fibroids. In most cases there are several fibroid nodules in the uterus, ranging in size from a few millimetres to impressive dimensions when their increased number and size can reach the size of a full-term pregnancy.
Cervical cancer surgery starts under the auspices of two basic principles: preserving the fertility of women of reproductive age who wish to bear children in the future, and individualized treatment, depending on the stage of the disease, the extent of the cancer and ways of preventing recurrence.
Cervical cancer surgery is divided into two types: early cervical cancer surgery, we are talking about stage 1A and 1B1, i.e. tumors under 2 cm, and advanced cervical cancer surgery, tumors over 2 cm, with the potential to spread and evolve.
Endometrial cancer affects women during menopause with a peak incidence in women aged 55-60. An increase in incidence has recently been observed in the under 50s, mainly due to the increasing impact of obesity in younger women. Initially, surgery for the disease consisted of the classical approach, but with time treatment by minimally invasive surgery has shown its superiority and benefits for patients.
Because it frequently occurs in older patients who find it difficult to tolerate general anaesthesia, a “milder” solution was sought that would provide oncologic targeted treatment.
The hysterectomy is the surgical procedure that involves the removal of the uterus. The total hysterectomy implies the removal of the uterus, as well as the cervix, the component which stabilizes the uterus by its attachment to the pelvic ligaments and is connected distally to the vagina.
The decision involving the removal the ovaries and the fallopian tubes is taken with regard to their ultra-sonographic and intraoperative aspect, the age and the pathology of the patient.
The procedure is done laparoscopically, under general anesthesia, by using four 5 mm incisions – one for the optical instrument and three for the surgical instruments. After identifying the urinary bladder and the ureters, the surgeon dissects the anatomical spaces surrounding the cervix, exposing the uterine arteries for visualization.
A polypropylene band is then placed around the uterine cervix, medially to the uterine vessels.
