Robotic Vaginectomy for Deep Infiltrating Rectovaginal Endometriosis

INTRODUCTION: Deep infiltrating endometriosis affects 1–2% of all women with endometriosis. This diagnosis is defined by endometrial implant invasion into peritoneal surfaces at a depth of greater than 5 mm most commonly located in the rectovaginal septum, uterosacral ligaments, pararectal space, and vesicouterine fold. Women typically present to their doctor with complaints of chronic pelvic pain, dysmenorrhea, dyspareunia, dyschezia, hematochezia, mictalgia, and infertility. Management includes medical and/or surgical management in order to provide relief from the commonly associated chronic pain symptoms. Surgical management involves the excision of endometrial implants with a multidisciplinary team of surgeons, including MIGS, urology, and/or colorectal surgery, depending on the location of endometrial implant involvement. OBJECTIVE: The goal of this video is to show the extensive dissection necessary in the excision of deep infiltrating rectovaginal endometriosis and to demonstrate vagina cuff reconstruction after extensive vaginal tissue excision. METHODS: This video was created to serve as a surgical educational video. RESULTS: Surgical excision of rectovaginal endometriosis provides definitive treatment for chronic pain symptoms associated with endometriosis. CONCLUSIONS: Laparoscopic excision of vaginal endometriosis should be considered as a management option in patients with recurrent or persistent symptoms of deep infiltrating endometriosis.