A Whole New “Endo-World” for a FMIGS: How to Start?

Study Objective to demonstrate a guide for a FMIGS (Fellow in Minimally Invasive Gynecological Surgery) who is starting in the endometriosis surgery, focusing on the nerve-sparing technique and the anatomical landmarks for excision of the endometriosis on the uterosacral ligament. Design step-by-step of surgical technique for uterosacral ligament exeresis through narrated surgical video, pointing out the anatomical landmarks Setting in semi-gynecological position, 10 mm port was placed on the umbilicus and 3 auxiliary ports were placed following the triangulation technique. Patients or Participants A 30-years old woman with chronic pelvic pain and dyspareunia with left uterosacral thickening on physical examination with suspicion of deep infiltrating endometriosis. Interventions A minimally invasive approach was done following the steps below: • Step 0: understand the disease with abdominal inspection • Step 1: exposure with temporary ovariopexy • Step 2: identification of anatomical landmarks: ureter and hypogastric nerve • Step 3: opening of the peritoneum, medially to the ureter • Step 4: exeresis of the uterosacral ligament superficially • Step 5: development the Okabayashi space • Step 6: exeresis of the uterosacral ligament deeply • Step 7: re-check the integrity of the anatomical landmarks - hypogastric nerves, ureter, uterine vessels, rectosigmoid Measurements and Main Results this video demonstrated the nerve-sparing technique with preservation of important anatomical landmarks for this type of surgery: hypogastric nerve, ureter, and uterine vessels. Conclusion Most of the endometriosis surgery complications are related with inadvertent lesion of the nerves. In order to avoid that, some authors described the nerve-sparing technique for deep infiltrating endometriosis. This is a surgery expected for a FMIGS to understand and perform after their training. Therefore, for a successful and safe surgery it is essential for the FMIGS to know the anatomical landmarks and the surgical technique to demonstrate a guide for a FMIGS (Fellow in Minimally Invasive Gynecological Surgery) who is starting in the endometriosis surgery, focusing on the nerve-sparing technique and the anatomical landmarks for excision of the endometriosis on the uterosacral ligament. step-by-step of surgical technique for uterosacral ligament exeresis through narrated surgical video, pointing out the anatomical landmarks in semi-gynecological position, 10 mm port was placed on the umbilicus and 3 auxiliary ports were placed following the triangulation technique. A 30-years old woman with chronic pelvic pain and dyspareunia with left uterosacral thickening on physical examination with suspicion of deep infiltrating endometriosis. A minimally invasive approach was done following the steps below: • Step 0: understand the disease with abdominal inspection • Step 1: exposure with temporary ovariopexy • Step 2: identification of anatomical landmarks: ureter and hypogastric nerve • Step 3: opening of the peritoneum, medially to the ureter • Step 4: exeresis of the uterosacral ligament superficially • Step 5: development the Okabayashi space • Step 6: exeresis of the uterosacral ligament deeply • Step 7: re-check the integrity of the anatomical landmarks - hypogastric nerves, ureter, uterine vessels, rectosigmoid this video demonstrated the nerve-sparing technique with preservation of important anatomical landmarks for this type of surgery: hypogastric nerve, ureter, and uterine vessels. Most of the endometriosis surgery complications are related with inadvertent lesion of the nerves. In order to avoid that, some authors described the nerve-sparing technique for deep infiltrating endometriosis. This is a surgery expected for a FMIGS to understand and perform after their training. Therefore, for a successful and safe surgery it is essential for the FMIGS to know the anatomical landmarks and the surgical technique