458: Beyond Boundaries: Advanced Surgical Management of Extrapelvic and Complex Endometriosis by the MIGS Surgeon

Monday, November 16, 2026
3:30 pm - 4:30 pm

Room: RM312

Chairs: Nucelio Lemos

Faculty: Ricardo M.A. Pereira, Horace Roman, William Kondo, Nucelio Lemos

Description: The surgical management of advanced endometriosis increasingly requires gynecologic surgeons to develop expertise beyond traditional gynecologic excision techniques. Complex disease involving the diaphragm, bowel, urinary tract, and lumbosacral plexus has historically relied on multidisciplinary surgical teams with strategies dictated by thoracic surgeons, colorectal surgeons, urologists, or neurosurgeons. However, a new generation of highly specialized MIGS surgeons has demonstrated that many of these procedures can be safely and effectively performed within advanced gynecologic practice, with better outcomes due to a more disease-oriented approach, while maintaining strong collaborative relationships with supporting specialties.

This Surgical Tutorial brings together internationally recognized pioneers who have developed some of the largest and most influential surgical experiences in the literature for complex endometriosis. Ricardo Pereira will discuss the diagnosis and surgical management of diaphragmatic and pericardial endometriosis, based on the world’s largest reported experience in thoracic endometriosis. Horace Roman will review surgical strategies for sacral plexus and lumbosacral endometriosis, including nerve-sparing approaches and decision-making in deeply infiltrative neural disease. William Kondo will present contemporary techniques for bowel endometriosis excision—including shaving, discoid excision, segmental resection, and NOSE approaches—while focusing on strategies associated with exceptionally low leak rates in one of the largest published bowel endometriosis series worldwide. Nucelio Lemos will discuss advanced urinary tract endometriosis surgery, including bladder reconstruction, ureterolysis, ureteric reanastomosis, and ureteral reimplantation, based on over 15 years of experience in complex genitourinary disease management within a MIGS and urogynecology practice.

More importantly, this session will address the broader evolution of MIGS toward surgical independence in the treatment of complex endometriosis. Faculty will discuss how gynecologic surgeons can safely expand their surgical scope, develop advanced reconstructive skills, and build collaborative multidisciplinary networks that provide support during complications and highly complex cases. Emphasis will be placed on how this independence improves overall surgical judgment, patient selection, complication avoidance, and practical strategies for safely integrating these techniques into advanced endometriosis practice.

Learning Objectives: At the end of this course, the participant will be able to:

1. Describe contemporary surgical approaches for diaphragmatic, bowel, urinary tract, and lumbosacral plexus endometriosis, including key technical considerations and anatomical landmarks;
2. 2. Compare the indications, advantages, limitations, and complication profiles of shaving, discoid excision, segmental bowel resection, and NOSE techniques for rectosigmoid endometriosis;
3. 3. Identify surgical strategies to minimize major complications in advanced endometriosis surgery, including anastomotic leak, ureteral injury, fistula formation, and neurologic dysfunction;
4. 4. Discuss reconstructive options for advanced urinary tract endometriosis, including ureterolysis, ureteric reanastomosis, ureteral reimplantation, and bladder reconstruction; and
5. 5. Evaluate how advanced MIGS surgeons can safely expand their surgical scope in complex endometriosis while building effective multidisciplinary collaboration with colorectal surgery, thoracic surgery, urology, and neurosurgery teams.

COURSE OUTLINE

3:30 PM Welcome, Introduction and Course Overview

N. Lemos

3:35 PM Diaphragmatic and Pericardial Endometriosis: Surgical Anatomy, Techniques, and Pitfalls

R. Pereira

3:45 PM Sacral Plexus and Lumbosacral Endometriosis: Nerve-Sparing Strategies and Surgical Decision-Making

H. Roman

3:55 PM Bowel Endometriosis: Shaving, Discoid, Segmental and Nose Techniques with Leak Prevention Strategies

W. Kondo

4:05 PM Advanced Urinary Tract Endometriosis: Bladder Reconstruction, Ureteric Anastomosis and Reimplantation

N. Lemos

4:15 PM Discussion Questions & Answers

4:30 PM Adjourn