Robotic techniques in endometriosis: six steps for excision of rectovaginal nodules - the butterfly method

OBJECTIVE: To present a standardized and reproducible approach for the surgical excision of deep endometriosis in the rectovaginal septum, represented by #ENZIAN A. DESIGN: Surgical video article. SETTING: A tertiary referral center. PATIENT(S): The case of a patient with an isolated endometriotic nodule in the rectovaginal septum was used to illustrate the surgical technique, also referred to as the butterfly method. INTERVENTION(S): An Intuitive Xi DaVinci system was used at the tertiary referral center, IFEMEndo in Bordeaux, France. Patient consent was obtained. MAIN OUTCOME MEASURE(S): Step-by-step approach for the excision of endometriosis in the rectovaginal septum. RESULT(S): This educational film presents a systematic approach dividing the surgical procedure into following six steps: We used the metaphor of the butterfly because it comprehensively and pictorially reflects the resection line of the endometriotic nodule in the rectovaginal septum. CONCLUSION(S): Surgical management of rectovaginal endometriosis can be challenging and requires as much as possible the preservation of autonomic nerves. A systematic approach enables the endoscopists to perform a safe and complete removal of the lesion.