Laparoscopic Excision of Obturator Nerve Endometriosis: A Stepwise Approach

OBJECTIVE: To demonstrate a reproducible approach to the laparoscopic excision of endometriosis involving the obturator nerve. SETTING: Academic tertiary care hospital. PARTICIPANTS: Case of a 30-year-old woman found on MRI to have a 1.6 cm endometriosis nodule involving the left obturator nerve, along with adenomyosis, rectovaginal, and ureteric endometriosis. Due to symptoms refractory to medical management, a laparoscopy is performed to excise the obturator nerve lesion, in addition to a disc rectal excision and ureteral reimplantation. INTERVENTIONS: Laparoscopic excision of obturator nerve endometriosis. CONCLUSION: Excision of obturator nerve endometriosis by laparoscopy can be safely performed with a thorough knowledge of anatomy and a systematic dissection of pelvic spaces. MRI is essential for preoperative planning in these rare forms of deep infiltrating endometriosis.