A step-by-step approach to a frozen pelvis

Area of Science:

• Reproductive Surgery
• Minimally Invasive Gynecological Surgery
• Surgical Anatomy

Background:

• Frozen pelvis, characterized by distorted pelvic organs due to adhesions, presents significant surgical challenges, particularly in endometriosis-associated infertility.
• Accurate identification of anatomical landmarks and surgical planes is crucial to minimize operative risks.
• A systematic approach is essential for safe and efficient dissection in complex pelvic cases.

Observation:

• The video details a step-by-step surgical technique for restoring pelvic anatomy in a patient with stage IV endometriosis and a frozen pelvis.
• Key steps include abdominopelvic survey, sigmoid colon mobilization, bilateral ureterolysis, adnexal mobilization, and dissection of the medial pararectal and rectovaginal spaces.

Findings:

• The presented surgical approach facilitated complete excision of endometriosis with minimal blood loss (45 mL) and an uncomplicated procedure.
• The patient experienced symptom resolution and an uneventful recovery, with same-day discharge.
• Restoration of normal anatomy allowed for completion of planned surgical procedures.

Implications:

• This systematic approach can enhance the safety and efficiency of surgical management for frozen pelvis.
• Mastery of this technique can improve outcomes for patients with severe endometriosis and infertility.
• The described method provides a valuable educational tool for reproductive surgeons facing complex pelvic adhesions.