METHOD OF EXCISION OF DEEPLY INFILTRATIVE RETROCERVICAL ENDOMETRIOSIS LESIONS UNDER TACTILE RECTOVAGINAL CONTROL

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Aim. To create a safe and efficient method of excision of deeply infiltrative retrocervical endometriosis lesions. Material and Methods. Research includes analysis of 82 cases of deeply infiltrative retrocervical endometriosis surgery, which were performed from October 2014 to May 2018. Results and Discussion. In recent years, due to the improvement of diagnostic methods frequency of detection of retrocervical endometriosis has increased significantly and, according to various authors, comprise 30-34% of all cases of endometriosis (Tarlamazian A. V., Stolyarova U. V., 2016). Gold standard in treatment of this pathology is a surgical method, aimed at a maximal elimination of endometriosis lesions, with consequent hormone-modulating therapy. Excision of retrocervical endometriosis lesions is a technically complicated surgical intervention and requires detailed knowledge of true pelvis anatomy from surgeon. In case of lesions removal under a visual control there is a high risk of vaginal and rectal injuries and incomplete excision is probable. In order to reduce such risks visual control should be complemented with a tactile one. Surgeon with an L-hook electrode in his right hand excises endometriosis lesion within healthy tissues. At a moment of excision he controls posterior vaginal fornix with an index finger of left hand; middle finger, inserted into rectum, serves to assess integrity of its wall. Assistant using endoscopic tool in his right hand provides tension on being removed tissue in a direction of dissection. Due to a different density of surrounding tissues and endometriosis lesion, surgeon controls completeness of excision with his left hand fingers. Conclusions. Tactile rectovaginal control during excision of retrocervical endometriosis lesions contributes to reducing of probability of hollow organs perforation (among 82 cases only one was complicated by perforation of vagina; there were no cases of rectum perforation). At the same time this method provides maximal elimination of endometriosis lesions within healthy tissues.