Deep endometriosis surgery is among the most advanced laparoscopic procedures performed today. It requires meticulous dissection of pelvic and abdominal organs affected by endometriosis, while preserving critical structures such as the pelvic nerves. At EndoGlobal Group, this surgery is conducted using a multidisciplinary approach and high-precision techniques to ensure optimal outcomes and quality of life …
Deep endometriosis surgery is among the most advanced laparoscopic procedures performed today. It requires meticulous dissection of pelvic and abdominal organs affected by endometriosis, while preserving critical structures such as the pelvic nerves. At EndoGlobal Group, this surgery is conducted using a multidisciplinary approach and high-precision techniques to ensure optimal outcomes and quality of life improvement for patients.
Laparoscopic Access and Trocar Placement
For optimal exposure, the surgical team uses four abdominal trocars:
- One umbilical trocar (10–12 mm) for laparoscope insertion
- Three additional 5 mm trocars in the right and left iliac regions and the suprapubic area
- In advanced cases, a fifth auxiliary trocar may be used to aid mobilization
The patient is placed in lithotomy position, which facilitates access to the rectum and vagina for dissection and lesion removal. Pneumoperitoneum with CO₂ is established via the umbilical trocar to safely access the peritoneal space.
Surgical Phases
Inspection and Anatomical Restoration
Surgery begins with a full inspection of the abdominal and pelvic cavity. The main objective is to restore the normal anatomical structure that has been altered by endometriosis.
Dissection of Avascular Spaces
- Key pelvic structures such as the ureters and pelvic nerves are carefully lateralized
- Temporary ovarian suspension to the abdominal wall may be used to enhance visibility
Nerve Protection and Advanced Dissection
- Dissection of the pararectal space is carried out while preserving the hypogastric nerves
- If lesions infiltrate the parametrium or paravaginal tissues, dissection may extend to the pelvic floor and obturator muscles, ensuring the preservation of the obturator and sciatic nerves
Segmental Peritoneal Resection
- All visible endometriotic nodules are completely removed to ensure thorough excision
- A minimal uterine manipulator is used to maximize exposure without compromising tissue integrity
Excision Techniques and Instrumentation
The method of lesion excision depends on the type of tissue and surgical complexity. At EndoGlobal Group, the following instruments are used:
- Laparoscopic scissors
- Monopolar hook
- Ultrasonic dissector
- LigaSure forceps
- Laser dissector
Multidisciplinary Approach for Advanced Cases
EndoGlobal Group specializes in performing extensive resections in a single procedure to avoid repeated surgeries. This may include:
- Resection of endometriotic nodules
- Intestinal and bladder resections
- Diaphragmatic lesion removal
- Repair of muscular defects
- Hepatic resections in cases of liver involvement
This comprehensive approach ensures preservation of organ function and minimizes the risk of complications.
Deep endometriosis surgery is a complex and delicate intervention that requires a high level of surgical expertise. At EndoGlobal Group, our team applies advanced laparoscopic techniques and a personalized approach for each patient, delivering precise outcomes and supporting long-term recovery.
Contact us to learn more or schedule a consultation.
