Stepwise approach to the laparoscopic excision of bladder endometriosis

OBJECTIVE: To describe a stepwise approach to the laparoscopic excision of bladder endometriosis. DESIGN: Narrated surgical video. SETTING: Academic tertiary care hospital. PATIENT(S): Surgical footage was obtained from three patients who underwent surgery for bladder endometriosis. Institutional review board approval was not required in accordance with the Tri-Council Policy Statement of Canada, article 2.5. INTERVENTION(S): Laparoscopic excision of bladder endometriotic nodules by partial cystectomy. MAIN OUTCOME MEASURE(S): Overview of the relevant anatomy, disease overview, surgical planning and perioperative care, and the approach to the excision of bladder endometriotic nodules. RESULT(S): The approach to excision of bladder endometriotic nodules can be standardized in six reproducible steps: cystoscopy with or without ureteral stent placement; abdominal survey and treatment of posterior compartment disease; bladder mobilization; partial bladder cystectomy under cystoscopic guidance; cystotomy closure; and water-leak test. CONCLUSION(S): The safe and complete excision of bladder endometriosis relies on the understanding of surgical anatomy, the multidisciplinary aspect of patient care, and the standardization of the surgical approach.