Approach to Excision of Superficial Endometriosis

Apr 15, 2019 | 250 Views

Michael Suen, Cici Zhu, Kristina Arendas, Sukhbir Sony Singh

This video describes a two-step approach to the excision of superficial endometriosis.

En Bloc Resection of Deep Infiltrating Endometriosis with a Novel Tissue Extraction and Anastomotic

Jul 8, 2019 | 191 Views

Brigid Nee, Sarah Mah

This video demonstrates the use of natural orifice vaginal extraction for the completion of a laparoscopic bowel resection in the setting of deep infiltrating endometriosis.

Deep Endometriosis of the Bowel: A Surgical Approach

Sep 27, 2019 | 179 Views

Cici Zhu, Michael Suen, Shaheer Tadros, Sukhbir Sony Singh

The objectives of this video are to define bowel endometriosis and to explore various surgical parameters for the different types of surgical excision. Then, a specific surgical approach will be demonstrated. When planning a surgical approach to deep endometriosis of the bowel, patient characteristics such as age and BMI, as well as their specific symptoms and level of pain, quality of life and fertility goals must be considered. As well, the actual lesion must be investigated with respect to size, number, location, depth of infiltration, and amount of intestinal wall circumference involved. Then, various surgical techniques can be performed depending on these specific characteristics, such as nodule shaving, nodular resection and segmental resection and re-anastomosis. A surgical case is then utilized to demonstrate a nerve sparing and blood supply conserving technique of segmental resection after intra-operative sigmoidoscopy demonstrated luminal obstruction.

Parametrial Endometriosis Part 3: Introducing a Nerve Sparing Technique to the Parametrectomy

Sep 24, 2020 | 16 Views

Darl Edwards, Zi Ying Zhao, Jonathon Solnik, Nucelio Lemos

This is the third video of a series introducing the concept of parametrial endometriosis (PE) and describing our surgical approach in treating this particular disease presentation. The objective of this video is to review the anatomy and innervation of the parametrium and introduce the surgical technique and efficacy of the Laparoscopic Nerve-Sparing Ultralateral Resection (LaNSURe) of PE. This educational video introduces the nerve-sparing surgical treatment of PE and reviews initial results of a retrospective review of these patients. It is a compilation of anatomy schematics and surgical video clips demonstrating the novel LaNSURe surgical technique in patients diagnosed with PE. PE is a unique presentation of endometriosis with a specific constellation of signs and symptoms. This video introduces the surgical technique of our novel LaNSURe surgical technique of PE which has demonstrated encouraging initial results improving pain and quality of life. Long-term follow up will be completed in the future.

Parametrial Endometriosis Part 2: Clinical Diagnosis and Correlation of Medical Imaging with Laparos

Sep 24, 2020 | 18 Views

Darl Edwards, Zi Ying Zhao, Jonathon Solnik, Nucelio Lemos

This is the second video of a series introducing the concept of parametrial endometriosis (PE) and describing our approach to diagnosing and treating this particular disease presentation. The objective of this video is to discuss the presenting signs and symptoms associated to this condition as well as provide an approach for clinical workup and diagnosis. It is a compilation of anatomy schematics, medical imaging and surgical video clips demonstrating the anatomy, clinical and diagnostic findings, and describing the infiltration patterns of PE. We then present some pictorial cases correlating the clinical, imaging and surgical findings. PE is a unique presentation of endometriosis with a specific constellation of symptoms and clinical findings. This video series introduces this concept and teaches the approach to clinical diagnosis setting the bases for the next video in the series, which describes the surgical technique and results of the Laparoscopic Nerve-Sparing Ultralateral Resection (LaNSURe) of PE.

Parametrial Endometriosis Part 1: A Correlation of Parametrial Anatomy and Disease Presentation

Sep 24, 2020 | 28 Views

Darl Edwards, Zi Ying Zhao, Jonathon Solnik, Nucelio Lemos

This is the first video of a series introducing the concept of parametrial endometriosis (PE) and describing our approach to diagnosing and treating this particular disease. The objective of this video is to discuss anatomy and innervation of the parametrium and explain presenting signs and symptoms associated to this condition. This educational video includes a compilation of anatomy schematics, surgical video clips, and cadaveric dissections demonstrating the anatomy in the innervation of the parametrium and its correlation with the specific symptoms and signs of PE. This is part of an ongoing retrospective-prospective study that currently includes 28 patients who underwent surgical parametrectomies for the treatment of PE. PE is a unique presentation of endometriosis with a specific constellation of symptoms. This video introduces this concept and sets the fundamental anatomic bases for the next videos in the series which describe diagnosis, as well as the LaNSURe surgical technique.

Laparoscopic Ilioinguinal Nerve Excision

Sep 24, 2020 | 23 Views

Meghan O'Leary, Chandrew Rajakumar

Neuropathic pain refractory to other modalities of treatment is an indication for surgical management. This video follows a case of neuropathic pain in the distribution of the ilioinguinal nerve, as demonstrated with short-term resolution of symptoms after a nerve block. Relevant neuroanatomy will be reviewed, and laparoscopic excision of the ilioinguinal nerve will be demonstrated in a stepwise fashion. Resolution of her symptoms on post-operative pain mapping will also be shown.

Laparoscopic Excision of Pericardial and Diaphragmatic Endometriosis

Sep 24, 2020 | 40 Views

Dong Bach Nguyen, Sebastien Gilbert, Kristina Arendas, Caitlin Jago, Sukhbir Sony Singh

This video presents a five-step approach to the laparoscopic excision of pericardial and diaphragmatic endometriosis. Clinically, endometriosis affects the thoracic cavity in less than 1% of cases, most commonly involving the diaphragm and treated using a VATS approach. Pericardial endometriosis is an even rarer entity, with only 4 case reports published to date. We present the case of a 35-year-old in order to illustrate the approach to a laparoscopic excision of diaphragmatic and pericardial endometriosis. In consultation with the Thoracic team, she is consented for a completion surgery of thoracic endometriosis identified at a prior laparoscopy, symptomatic for right shoulder and mid-chest pain, and unresponsive to medical therapy. The surgical approach consists of 5 reproducible steps: 1. Upper abdominal survey 2. Liver mobilization 3. Excision of diaphragmatic and pericardial lesions 4. Intra-thoracic laparoscopic exploration 5. Closure of the diaphragmatic defect

Laparoscopic Ureteroureterostomy to Treat Severe Ureteral Endometriosis

Sep 24, 2020 | 52 Views

Rahana Harjee, Christopher H. Wu, Michael Suen

Deeply infiltrating endometriosis can involve the bladder and ureters; this educational video demonstrates the steps for a laparoscopic ureteroureterostomy for ureteric obstruction and highlights the advantages of a multi-disciplinary approach. A 29-year-old G0 was referred to Urology with right sided flank pain, with a past history of surgically-excised endometriosis. Imaging showed a 6.6 cm right adnexal mass, with proximal hydroureter and hydronephrosis. A multi-disciplinary surgical approach was planned with Urology and Gynecology. Excision of endometriosis was initially performed, which included superficial endometriosis, a rectovaginal nodule and endometrioma cystectomy. Complete ureteric stricture due to endometriosis was confirmed; a laparoscopic ureteroureterostomy was performed, with closure using a barbed suture. Her post-operative recovery was uncomplicated, and follow-up imaging and ureteroscopy showed decreased hydroureter, and no evidence of obstruction. This video demonstrates the surgical steps and collaborative surgical decision-making during a complicated case.