Deep Infiltrating Rectovaginal Endometriosis: Partial Vaginectomy and Anterior Discoid Resection

Study Objective

To demonstrate varying presentations of deep infiltrating rectovaginal endometriosis

Design

N/a- video submission

Setting

Conventional laparoscopic case with patient in dorsal lithotomy position

Patients or Participants

Two cases of deep infiltrating rectovaginal endometriosis, presenting with dysmenorrhea, dyspareunia and dyschezia, both requiring partial vaginectomy and anterior discoid resection, however of varying degrees.

Interventions

Complete resection of disease with partial vaginectomy and anterior discoid resection. Case 1 presents as classic stage 4 endometriosis with bilateral endometriomas. It demonstrates a larger partial vaginectomy, requiring resection of a portion of the vaginal mucosa in addition to a superficial longitudinal resection of a rectal nodule. Case 2 seemingly presents without overt evidence of stage 4 disease, however the rectal nodule involves full thickness of the bowel wall, requiring a transverse repair while the partial vaginectomy is smaller and able to spare the mucosa.

Measurements and Primary Results

Demonstrate surgical techniques to achieve complete resection of rectovaginal endometriosis including use of breisky retractors rather than the uterine manipulator, squeeze technique, tagging the nodule and developing the median pararectal space.

Conclusion

We demonstrate two cases of deep infiltrating rectovaginal endometriosis requiring varying degrees of surgical resection based on location and extent of disease. Case 1 requires more significant partial vaginectomy, while case 2 requires more significant anterior discoid resection. Both cases utilize the same surgical techniques, but are able to tailor to the individual's extent of disease.