8066 5 Levels of Ureteric Dissection

Study Objective To delineate, describe, and proceed on different levels of ureteric involvement of endometriosis. Design Several years of surgeries on patients suffering from endometriosis leaves the authors with some distinct characteristics, and best understood management styles for involvements of the disease with the ureter. Setting The patient is positioned in the dorsal lithotomy in Trendelenburg position. Primary tracer is through the umbilicus, 3 operative ports are used, 2 at respective right and left flank and middle at supra pubic port. Patients or Participants This learning in this video has been compiled over several years with learnings from numerous surgeries to empirically categorize ureteric involvement of endometriosis and the best ways to manage each of them. Interventions All surgeries in this video presentation are laparoscopic surgeries Measurements and Main Results The study breaks down ureteric involvement into 5 primary categories namely (1) Tease and cut (2) Laminar dissection (3) The virgin gateway (4) The Wertheim Worry and finally (5) The Choke Hold. The list is non-exhaustive, and each level presents us with a more intense involvement of the disease than the last. Conclusion Endometriosis is an anatomy altering disease that presents itself in several ways. No patients have the exact same disease expression, and many more levels of involvement can be listed. However, for the purpose of this study, these involvement do enough to explain to us how the involvement can be managed in a majority of cases. To delineate, describe, and proceed on different levels of ureteric involvement of endometriosis. Several years of surgeries on patients suffering from endometriosis leaves the authors with some distinct characteristics, and best understood management styles for involvements of the disease with the ureter. The patient is positioned in the dorsal lithotomy in Trendelenburg position. Primary tracer is through the umbilicus, 3 operative ports are used, 2 at respective right and left flank and middle at supra pubic port. This learning in this video has been compiled over several years with learnings from numerous surgeries to empirically categorize ureteric involvement of endometriosis and the best ways to manage each of them. All surgeries in this video presentation are laparoscopic surgeries The study breaks down ureteric involvement into 5 primary categories namely (1) Tease and cut (2) Laminar dissection (3) The virgin gateway (4) The Wertheim Worry and finally (5) The Choke Hold. The list is non-exhaustive, and each level presents us with a more intense involvement of the disease than the last. Endometriosis is an anatomy altering disease that presents itself in several ways. No patients have the exact same disease expression, and many more levels of involvement can be listed. However, for the purpose of this study, these involvement do enough to explain to us how the involvement can be managed in a majority of cases.