Intraoperative Delineation of Bladder Deep Endometriosis: Optimizing Excision Margins for Postoperative Bladder Capacity Preservation

Abstract

Study Objective

To demonstrate the implementation of robotic integrated ultrasound alongside meticulous dissection and cystoscopic guidance in the surgical excision of deep endometriosis nodules, to prevent persistent or recurrent disease without sacrificing normal bladder wall, thereby optimizing postoperative bladder capacity.

Design

This study presents a case report detailing the proposed surgical technique.

Setting

Academic tertiary referral center.

Patients or Participants

A 45-yo-woman with a history of hysterectomy for fibroids presenting with persistent symptoms suggestive of urinary tract infection and hematuria.

Interventions

Surgical excision with robotic assistance, cystoscopic guidance and incorporation of robotic integrated ultrasound for precise delineation of lesion margins.

Measurements and Main Results

The patient had an uneventful postoperative course with symptom resolution. Pathology confirmed full thickness endometriosis lesion with free margins.

Conclusion

The integration of intraoperative ultrasound with meticulous dissection and cystoscopic guidance represents a reproducible approach for the precise delineation of bladder deep endometriosis nodules. This technique is an effective methodology for optimizing excision margins while concurrently preserving the integrity of the normal bladder wall.