Nerve-sparing laparoscopic radical excision of deep endometriosis with rectal and parametrial resection.

摘要

The pelvic laparoscopic nerve-sparing approach for treatment of deep endometriosis starts retroperitoneally from the promontory. Blunt dissection of loose fatty tissue of the rectosacral and pararectal spaces to the level of the rectosac-ral-fascia and rectal wings enables identification of the sympathetic superior hypogastric plexus, hypogastric nerves, and lumbosacral trunks and ganglia. Moreover, identification of the parasympathetic pelvic splanchnic nerves at their origin from the sacral roots enables safe dissection of the rectal wings and of the posterior parametrial and lower mesorectal planes.