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

Sunday, November 15, 2026
11:00 Am - 12:30 pm

Room: RM306

Chair: Nucelio Lemos

Faculty: Shanda Blackmon, Marcello Ceccaroni, William Kondo, Ricardo M.A. Pereira

Description:

The surgical management of advanced endometriosis requires disease-specific expertise, advanced technical skills, and sound judgment regarding the appropriate scope of gynecologic surgery. Highly specialized MIGS surgeons increasingly serve as the primary operative specialists for complex disease involving the diaphragm, pericardium, bowel, urinary tract, and lumbosacral plexus, applying advanced excisional, nerve-sparing, and reconstructive techniques within gynecologic practice. Developing this expertise allows gynecologic surgeons to provide more comprehensive, disease-oriented care while improving patient selection, surgical planning, complication prevention, and continuity of treatment.

This Surgical Tutorial brings together internationally recognized experts with extensive experience in complex endometriosis surgery. Dr. Ricardo Pereira will discuss the diagnosis and gynecologic surgical management of diaphragmatic and pericardial endometriosis, including relevant anatomy, operative techniques, and potential pitfalls. Dr. Marcello Ceccaroni will review surgical strategies for sacral plexus and lumbosacral endometriosis, including nerve-sparing approaches and decision-making in deeply infiltrative neural disease. Dr. William Kondo will present contemporary techniques for bowel endometriosis excision, including shaving, discoid excision, segmental resection, and natural orifice specimen extraction (NOSE), with particular attention to anastomotic leak prevention. Dr. Nucelio Lemos will discuss advanced urinary tract endometriosis surgery, including bladder reconstruction, ureterolysis, ureteric reanastomosis, ureteral reimplantation, and bladder reconstruction.

A central theme of the session will be how MIGS surgeons can safely expand their operative scope and develop the excisional and reconstructive capabilities required to manage complex endometriosis independently. Faculty will discuss practical strategies for acquiring these skills, selecting appropriate patients, preventing and managing complications, and building collaborative networks that remain available for support when needed.

Rare extra-abdominal manifestations, including endometriosis involving the central nervous system, nasopharyngeal region, joints, and other distant sites, represent important exceptions to this concept of gynecologic surgical independence. These uncommon presentations illustrate the boundaries of gynecologic practice and the continuing importance of collaboration with other surgical specialties. To provide the perspective of a collaborating specialty, Dr. Shanda Blackmon will present the thoracic surgical approach to supradiaphragmatic disease and introduce a proposed classification of diaphragmatic and thoracic endometriosis. This framework will help define disease distribution, guide operative planning, and clarify when management by the gynecologic surgeon or collaboration with a thoracic surgeon is most appropriate.

COURSE OUTLINE

11:00 AM Welcome, Introduction and Course Overview
N. Lemos

11:05 AM Diaphragmatic and Pericardial Endometriosis: Surgical Anatomy, Techniques, and Pitfalls
R. Pereira

11:15 AM Sacral Plexus and Lumbosacral Endometriosis: Nerve-Sparing Strategies and Surgical Decision-Making
M. Ceccaroni

11:25 AM Bowel Endometriosis: Shaving, Discoid, Segmental and Nose Techniques with Leak Prevention Strategies
W. Kondo

11:35 AM Advanced Urinary Tract Endometriosis: Bladder Reconstruction, Ureteric Anastomosis and Reimplantation
N. Lemos

11:45 AM Thoracic Endometriosis: Complex Care, Standards and Outcomes
S. Blackmon

11:55 AM Discussion Questions & Answers

12:30 PM Adjourn