Excision of endometrial implant

Excision of endometrial implant

Within the scope of the concept of conservative management of endometriosis, in which the primary aim is to preserve menstrual and ovarian function, there is logic in removing peritoneal implants which are prone to occur on the peritoneal floor, uterosacral ligaments and serosal surface of the bowel, provided the surgeon exercises reasonable care in so doing. The implant is more likely to produce severe dysmenorrhea and dyspareunia than far more extensive endometriosis within the ovary.

Some surgeons like to cauterize these areas. We prefer to excise them. The stellate scar surrounding the endometrial implant frequently involves only the peritoneum or serosal surface. The individual implants thus lend themselves to excision.

Best surgeon tutorials: Excision of endometrial implant

Figure 1. Exposure is provided by traction on a figure-of-eight suture placed in the fundus while the assistant retracts the sigmoid and elevates tube and ovary with a Babcock clamp. The Allis clamp often used may cause tissue damage.

Figure 2. The surgeon elevates the peritoneal flap and carefully dissects beneath it.

Figure 3. The peritoneum is then closed with interrupted atraumatic catgut sutures.

Excision of endometrial implant

Best surgeon tutorials: Excision of endometrial implant

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