Robotic techniques in endometriosis: six steps for excision of rectovaginal nodules - the butterfly method

Abstract

Objective: To present a standardized and reproducible approach for the surgical excision of deep endometriosis in the rectovaginal septum, represented by #ENZIAN A.

Design: Surgical video article.

Setting: A tertiary referral center.

Patient(s): The case of a patient with an isolated endometriotic nodule in the rectovaginal septum was used to illustrate the surgical technique, also referred to as the butterfly method.

Intervention(s): An Intuitive Xi DaVinci system was used at the tertiary referral center, IFEMEndo in Bordeaux, France. Patient consent was obtained.

Main outcome measure(s): Step-by-step approach for the excision of endometriosis in the rectovaginal septum.

Result(s): This educational film presents a systematic approach dividing the surgical procedure into following six steps: We used the metaphor of the butterfly because it comprehensively and pictorially reflects the resection line of the endometriotic nodule in the rectovaginal septum.

Conclusion(s): Surgical management of rectovaginal endometriosis can be challenging and requires as much as possible the preservation of autonomic nerves. A systematic approach enables the endoscopists to perform a safe and complete removal of the lesion.

Keywords: Endometriosis; rectovaginal septum; robotic surgery.