Robotic Excision of Deep Infiltrating Endometriosis of the Fallopian Tube

INTRODUCTION: Endometriosis is defined as ectopic endometrial-like deposits outside of the uterine cavity. Prevalence of fallopian tube endometriosis ranges from 6.9% to 69%. Endometriosis of the fallopian tube may cause distortion of normal tubal anatomy, contributing to dysmenorrhea, pelvic pain, and infertility. While excision of endometriosis can be considered, concern for compromise of fallopian tube integrity may lead to salpingectomy if damage or distortion is suspected. There is little data or cases examining excision of endometriosis from around the fallopian tube while maintaining tubal integrity. The case involves a 37-year-old G0P0 with a history of dysmenorrhea and infertility. The decision was made to proceed with a robotic-assisted excision of endometriosis. Upon initial abdominal survey, a congenitally absent right fallopian tube was discovered along with suspected findings of endometriosis surrounding the left fallopian tube. OBJECTIVE: Highlight an interesting case of deep infiltrating endometriosis involving the fallopian tube. Discuss surgical techniques for excision of endometriosis with fallopian tube preservation in a patient desiring future fertility. METHODS: This is a surgical video presentation of a robotic approach to an excision of deep infiltrating endometriosis surrounding the fallopian tube. RESULTS: This video provides an overview of endometriosis and preoperative workup for dysmenorrhea. Key principles of the video include reviewing relevant anatomy such as the fallopian tube, mesosalpinx, round ligament and infundibulopelvic ligament. This video highlights the use of electrosurgery versus sharp dissection to help decrease thermal spread to surrounding structures as well as techniques to preserve the fallopian tube lumen. Use of a tubal dye test can also help illuminate tubal patency. CONCLUSIONS: This video highlights successful excision of deep infiltrating endometriosis of the fallopian tube while preserving lumen integrity. Excision of endometriosis on or near the fallopian tube may be considered where appropriate in patients seeking fertility preservation.