Seven-Step Approach to Deconstructing the Obliterated Posterior Cul-De-Sac

Abstract

Study Objective

This video demonstrates a systematic approach to safely and efficiently normalize the obliterated posterior cul-de-sac for complete endometriosis excision. The seven-step technique provides a framework for learners to approach this complex endometriosis surgery. Learning theory supports breaking down a complex task into smaller parts which reduces learner cognitive load and provides a focus for feedback.

Design

Educational Tutorial

Setting

Academic Hospitals

Patients or Participants

Three patients with deep endometriosis with obliteration of the posterior cul-de-sac.

Interventions

Excision of endometriosis was completed using a specific technique involving seven steps. Steps included 1) prepare the pelvis, 2) identify the uterosacral ligaments, 3) perform ureterolysis if required, 4) separate the uterosacral ligaments from the rectum, 5) develop the distal rectovaginal space, 6) separate the rectum from the main adhesion point, and 7) excise the remaining endometriosis.

Measurements and Primary Results

Robotic-assisted laparoscopic excision of endometriosis was completed without unintended injury to surrounding structures.

Conclusion

This video demonstrates a reproducible surgical technique that can be reliably utilized by learners to obtain efficiency and confidence in completely excising endometriosis in the setting of an obliterated posterior cul-de-sac.