#Excision #Deep #Vaginal #Endometriosis #Nodule #Hassan #Morsi
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This patient had multiple laparoscopies with previous excision of endometriosis. Surgical retro-peritoneal planes are often very difficult to find in such cases (compared to primary surgery for endometriosis excision). Significant large bowel adhesions obscuring the pelvis.
Left tube and ovary (with small dermoid cyst) completely buried in the left pelvic wall. Left ovarian remnant removed in a subsequent step (down to the left ureter) after removal of the adherent left tube/ovarian mass.
Repeated finger palpation by the operating surgeon helps in ensuring all the nodule is removed. Opening of the vagina was not necessary as it was not a full thickness nodule. Vaginal and rectal probes are essential.
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