#326 Parametrial endometriosis-2Step excision with VR reconstruction- Dr. Rooma Sinha

This is one of the 2023 KS International Innovation Awards videos selected for inclusion in the Vattikuti Foundation – ORSI Humans on the Cutting Edge of Robotic Surgery Conference, October 6, 7 & 8, 2023 in Ghent, Belgium. Posting does not imply that is has been selected as a Finalist, just that the content will be discussed at the Conference.

From the entry: ABSTRACT

2 Step parametrial Endometriosis excision with 3D VR reconstruction Sinha Rooma, Alapati Kishore, Bana Rupa, Raina Rohit, Moumita Bag Apollo Hospitals, Hyderabad India

Objective – The objective of this video is to describe a technique or two-step excision of parametrial endometriosis nodule involving the ureter, rectum and vagina. We used MRI images as well as its 3-D virtual reality reconstruction for pre- operative planning.

Case description- a 31-year-old married for the last six months presented with severe dyspareunia (VAS 10/10) and severe dysmenorrhea (Vas 7/10). She had dysmenorrhea since merache however, had increased intensity of pain for the last two years. Her menstrual cycles were regular with normal flow. She also had associated symptoms of bloating, defecatory pain, and sense of incomplete bowel evacuation during her periods. Speculum evaluation as well as examination under anesthesia showed an indurated mass infiltrating the left vagina fornix. And initial biopsy confirmed endometriosis. After a pre-operative evaluation with both MRI images as well as the virtual reality reconstruction decision to perform robot assisted two-step excision of this parametrial endometriosis involvement with a detailed counselling was done. The steps of the procedure is highlighted in the video that is being submitted. The excised specimen from the parametrium confirmed endometriosis on histopathology. At three months evaluation the patient had considerable improvement in her dyspareunia as well as dysmenorrhea with no defeactory difficulty.

Conclusion– Complete excision of the endometriosis nodule is important for symptom relief. Preoperative precise planning and understanding the extent of involvement gives the surgeon an insight to the surgical steps. Robot assistance with its wrist movement as well as tremor filtration gives precise surgical expertise in tight and narrow pelvic spaces.

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