Design: Operative video/retrospective case study

Setting: An academic-affiliated community teaching hospital

Patients or Participants: A single patient who underwent laparoscopic surgery for symptoms of pelvic pain with stage IV endometriosis.

Interventions: Laparoscopic complete radical wide field peritonectomy and endometriosis excision

Measurements and Main Results: This case was selected retrospectively based on intraoperative footage of stage IV endometriosis, including a DIE lesion overlying the bladder, and use of high-power noncontact monopolar scissor electrosurgery for an optimal endometriosis resection. Specimens were meticulously labelled based on anatomic location and sent to pathology. Biopsy results were compared to operative footage to confirm sites of biopsy-proven endometriosis including the bilateral pelvic sidewalls, anterior cul de sac, and right pararectal peritoneum. Operative video was edited to show our standard approach to navigating complex endometriosis, as well as the utility of this method for complete peritonectomy and endometriosis resection in challenging anatomic locations.

Conclusion: Here we demonstrate a safe, easy, and versatile approach to laparoscopic radical wide field peritonectomy for complex endometriosis. Fine dissection with high-wattage noncontact monopolar electrosurgery, when applied correctly, is a safe method of endometriosis excision, which minimizes tissue trauma and enables surgeons to more completely resect complex lesions over critical structures. Research shows peritonectomy improves patients' pain, therefore it's important to promote methods to achieve this safely. This patient reported significantly decreased pain post-op following a complete radical pelvic peritonectomy and endometriosis excision. Finally, the instruments used in this video are all inexpensive, reusable, and widely available; making this technique a sustainable and translatable approach across institutions.