31 years old G:1 P:1 was referred b/o debilitating pelvic pain, heavy menstrual blood loss and dysparunia. Patient has h/o laparoscopically proven stage IV endometriosis about 5 years ago which was managed with medically following surgery, recently was evaluated again by a university prof and after hysteroscopy patient was told she is un-operable and has to live with her disease. Pre-Op Transvaginal pelvic ultrasound revealed Large multi-septated Endometrioma 10 and 6 cm in diameter on (R) & (L) ovaries, uterine size was reported to be 75 mm in length.
Clinical exam: Large 18 to 20 weeks size pelvic abdominal cystic mass, pelvic exam the same plus small nodularity at posterior cul de sac.
Patient was operated laparoscopically on 5 July 2013, consisted of, extensive dissection of retroperitoneal space and structures including ureters, anterior trunk of both hypogastric arteries with ligation, dissection of para-vesical and para-rectal spaces along with resection of pelvic floor DIE and TLH BS&O, total operation time was close to 3 hours.
Patient did very well post OP and was discharged home on second post operative day.