Laparoscopic Excision of Obturator Nerve Endometriosis: A Stepwise Approach

Area of Science:

• Gynecologic surgery
• Minimally invasive procedures
• Pelvic anatomy

Background:

• Endometriosis involving the obturator nerve is rare and challenging to manage.
• Deep infiltrating endometriosis requires precise surgical techniques for optimal outcomes.
• Magnetic resonance imaging (MRI) is crucial for preoperative diagnosis and surgical planning.

Purpose of the Study:

• To present a reproducible laparoscopic approach for excising endometriosis of the obturator nerve.
• To highlight the anatomical considerations and dissection techniques for this specific condition.
• To demonstrate the safety and efficacy of minimally invasive surgery for complex endometriosis.

Main Methods:

• A narrated surgical video details a case of a 30-year-old woman with obturator nerve endometriosis.
• The procedure involved laparoscopic excision of the obturator nerve lesion, alongside treatment for adenomyosis and other endometriosis sites.
• Key surgical steps included systematic dissection of pelvic spaces: iliolumbar, pararectal, and obturator.

Main Results:

• Successful laparoscopic excision of a 1.6 cm endometriosis nodule involving the left obturator nerve.
• The surgical technique involved a six-step approach, ensuring thorough dissection and nodule release.
• The patient also underwent treatment for associated adenomyosis, rectovaginal, and ureteric endometriosis.

Conclusions:

• Laparoscopic excision of obturator nerve endometriosis can be safely performed.
• A comprehensive understanding of pelvic anatomy and systematic dissection are critical for success.
• Preoperative MRI is essential for planning the surgical management of rare deep infiltrating endometriosis cases.