Anatomically Based Surgical Dissection for Deep Endometriosis Surgery

For century’s surgical education based on a learning-by-doing apprenticeship model using a high patient volume to teach the residency step by step certain surgical skills under various levels of supervision. Mistakes and costs resulting from the trainee’s learning curve were accepted by the society. Several studies evaluated the effect of repeating surgical interventions to iatrogenic injury and found an association between number of repetitions and declining injury rates also other associations were found correlating to repetition such as operative time, operative result etc. Deep endometriosis surgery is very challenging and knowledge about retroperitoneal anatomy, together with a method to approach the disease, are fundamental to avoid complications related to this complex surgery. In this chapter, an overview about retroperitoneal anatomy will be presented and a simplified step-by-step approach will be discussed to open retroperitoneal spaces, dissect the structures that need to be spared and excise the disease in an adequate way.