1 2 3 4 5 6 7 8 9 10 11 12 13 Q3 Horace Roman, MD, PhD*, Kirana Arambage, MD, Geoffroy Pasquier, MD, Benoit Resch, MD, 14 Q1 and Emmanuel Huet, MD 15 From the Departments of Gynecology and Obstetrics (Drs. Roman and Resch), Urology (Dr. Arambage), Surgery (Dr. Huet), Rouen University Hospital, 16 Rouen, France, and Department of Gynaecology (Dr. Pasquier), John Radcliffe Hospital, Oxford, United Kingdom. 17 18 ABSTRACT Study Objective: To report the combined cystoscopic and laparoscopic approach in deep endometriosis with full-thickness 19 infiltration of the bladder. 20 Q2 Design: Video (Canadian Task Force classification xx). 21 Setting: University hospital. 22 Patient: A 34-year-old nulliparous woman with a large (35-mm) endometriosis nodule infiltrating the bladder and deep endo23 metriosis of the rectum and sigmoid colon. Intervention: The urologic surgeon performed cystoscopy, identified the limits of mucosal involvement, and incised the 24 muscular layer up to fat tissues surrounding the bladder. The gynecologic surgeon identified and followed the circular incision, 25 and completed full-thickness resection of the bladder wall. Surgical technique reports in anonymous patients are exempt from 26 ethical approval by the institutional review board. 27 Measurements and Main Results: The patient’s functional outcome was uneventful. Laparoscopic resection of large endo28 metriotic nodules of the bladder per se may lead to inadvertent removal of healthy bladder muscle. Thus it increases the risk of 29 postoperative complications and symptoms due to small bladder volume. Conversely, if resection of the nodule is performed 30 only cystoscopically, it probably would not be completely removed. We routinely combine the 2 approaches because this en31 ables complete resection of the endometriotic nodule. It not only averts the risk of excessive removal of healthy bladder mus32 cle but also leaves no disease behind. 33 Conclusions: On the basis of our experience, we propose the combined cystoscopic and laparoscopic approach in managing 34 large endometriotic nodules with full-thickness infiltration of the bladder. Journal of Minimally Invasive Gynecology (2014) -, -–- Ó 2014 AAGL. All rights reserved. 35 36 Keywords: Bladder endometriosis; Cystoscopy; Deep endometriosis; Plasma energy 37 Use your Smartphone to scan this QR code 38 and connect to the DISCUSS You can discuss this article with its authors and with other AAGL members at 39 discussion forum for http://www.AAGL.org/jmig-21-4-JMIG-D-14-00051 this article now* 40 41 * Download a free QR Code scanner by searching for ‘‘QR scanner’’ in your smartphone’s app store or app marketplace. 42 Supplementary Data 43 44 Supplementary data related to this article can be found 45 online at http://dx.doi.org/10.1016/j.jmig.2014.02.009. 46 47 48 49 50 Dr. Roman has received personal fees from Plasma Surgical, Inc. (Roswell, E-mail:
[email protected] 51 GA), for participating in a symposium and a master class in which he preSubmitted February 12, 2014. Accepted for publication February 21, 2014. 52 sented his experience with the use of PlasmaJet. Available at www.sciencedirect.com and www.jmig.org Corresponding author: Horace Roman, MD, PhD, Clinique Gynecologique 53 et Obstetricale, CHU ‘‘Charles Nicolle,’’ 1 rue de Germont, Rouen, France. 54 55 1553-4650/$ - see front matter Ó 2014 AAGL. All rights reserved. 56 http://dx.doi.org/10.1016/j.jmig.2014.02.009
Combined Cystoscopic and Laparoscopic Approach in Deep Endometriosis of the Bladder
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References 1. Kovoor E, Nassif J, Miranda-Mendoza I, Wattiez A. Endometriosis of bladder: outcomes after laparoscopic surgery. J Minim Invasive Gynecol. 2010;17:600–604.
2. Rozsnyai F, Roman H, Resch B, et al., CIRENDO Study Group. Outcomes of surgical management of deep infiltrating endometriosis of the ureter and urinary bladder. JSLS. 2011;15:439–447. 3. Roman H, Pura I, Tarta O, et al. Vaporization of ovarian endometrioma using plasma energy: histologic findings of a pilot study. Fertil Steril. 2011;95:1853–1856.
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