Design: Description and demonstration of surgical technique.

Setting: Abdominal wall endometriosis has a reported incidence of 0.8-3.5% with pain onset usually occurring after pelvic surgery (i.e. cesarean section, other gyn procedure)¹. This diagnosis is unfortunately commonly overlooked in the primary work up of pelvic pain. There have been prior case reports supporting a minimally invasive approach to deep abdominal wall endometrioma resection. We provide further evidence in support of this approach.

Patients or Participants: N/A

Interventions: Surgical intervention with Advanced Gynecology and General Surgery via robot-assisted laparoscopic evaluation of the pelvis for recurrent endometriosis. Resection of recurrent intraperitoneal endometriosis and excision of deep abdominal wall endometrioma. Reduction and repair of ventral hernia with placement of abdominal wall mesh for reinforcement of weakened rectus muscle and closure of fascial defect using extraperitoneal robotic approach. Multimodal interventions for perioperative pain management.

Measurements and Main Results: N/A

Conclusion: Extraperitoneal robotic approach is a surgical option with less morbidity and improved pain control for resection of deep abdominal wall endometrioma and ventral hernia repair in an obese patient.

References

1. Cocco G, Delli Pizzi A, Scioscia M, Ricci V, Boccatonda A, Candeloro M, Tana M, Balconi G, Romano M, Schiavone C. Ultrasound Imaging of Abdominal Wall Endometriosis: A Pictorial Review. Diagnostics (Basel). 2021 Mar 29;11(4):609. doi: 10.3390/diagnostics11040609. PMID: 33805519; PMCID: PMC8065386.