Laparoscopic Excision of a Cervical Endometrioma

Abstract

Study Objective

To describe cervical endometriosis, a rare manifestation of endometriosis, to present an unusual case of cystic endometriosis involving the cervix, and to demonstrate strategies for tackling the obliterated posterior cul de sac.

Design

Educational video highlighting surgical techniques.

Setting

Academic medical center.

Patients or Participants

We present a case of a patient undergoing surgical management of deeply infiltrating endometriosis of the posterior cul de sac, including a cervical endometrioma.

Interventions

Laparoscopic excision of endometriosis, including resection of the cervical endometrioma, utilizing 3mm accessory ports.

Measurements and Main Results

We describe the etiology, presentation, and diagnosis of cervical endometriosis and review the deep and superficial subtypes of this condition. We review strategies for approaching the obliterated posterior cul de sac, including: 1) Optimizing exposure with mobilization of the sigmoid colon and ovarian retraction, 2) minimizing bleeding with uterine artery ligation and vasopressin injection, and 3) dissecting out the ureter to prevent injury. We demonstrate excision of a large rectovaginal nodule that required rectal shaving and a 3cm colpotomy to completely excise the lesion. Finally, we demonstrate excision of the cervical endometrioma utilizing ultrasonic energy.

Conclusion

Cervical endometriosis is rare manifestation of endometriosis that may require surgical management in symptomatic patients. This condition may arise from extension of deeply infiltrating endometriosis involving the posterior compartment. This video highlights strategies for approaching the obliterated posterior cul de sac and demonstrates the excision of an unusual cervical endometrioma. Additionally, this video demonstrates the feasibility of utilizing 3mm accessory ports in cases of advanced endometriosis.