Laparoscopic Excision of Endometriosis of theRectovaginal Septum by Diomed Laser

Overview

Objective:
Laparoscopic excision of deep endometriosis of rectovaginal septum and evaluation oftechnical capabilities of Diomed laser.Design: Prospective pilot study.Setting: Department of Gynaecology and Minimally Invasive Surgery, Na Homolce Hospital, Pra-gueMethods: Eight patients with clinically and laparoscopically diagnosed endometriosis of the recto-vaginal septum were selected for laparoscopic surgery. The extent of the lesion was assessed byvaginal palpations and laparoscopic visualisation of the Douglas space with a sponge forcepsinserted into the posterior vaginal fornix and using rectal probe simultaneously. To excluderectal wall infiltration baryum radiography was performed.Results: 7 out of 8 patients experienced a complete disappearence of symptoms such as dyspareu-nia, dysmenorrhea and pelvic pain. Follow - up is in the range of 1 - 12 months.Summary: Deep infiltrating rectovaginal endometriosis is a specific disease very different fromperitoneal or ovarian endometriosis. A more precise term is rectovaginal adenomyosis. Radical laparoscopic excision is needed. Although simple this is demanding pelvic surgery, the results aregratifying. The use of a laser seems superior to dissection technique.

Key words:
laparoscopy, endometriosis, rectovaginal septum, laser