Laparoscopic excision of endometriosis of the rectovaginal septum using the Diomed laser

Objective: Laparoscopic excision of deep endometriosis of rectovaginal septum and evaluation of technical capabilities of Diomed laser.

Methods: Prospective pilot study. Methods: Department of Gynaecology and Minimally Invasive Surgery, Na Homolce Hospital, Prague. Methods: Eight patients with clinically and laparoscopically diagnosed endometriosis of the rectovaginal septum were selected for laparoscopic surgery. The extent of the lesion was assessed by vaginal palpations and laparoscopic visualisation of the Douglas space with a sponge forceps inserted into the posterior vaginal fornix and using rectal probe simultaneously. To exclude rectal wall infiltration baryum radiography was performed.

Results: 7 out of 8 patients experienced a complete disappearance of symptoms such as dyspareunia, dysmenorrhea and pelvic pain. Follow-up is in the range of 1-12 months.

Conclusions: Deep infiltrating rectovaginal endometriosis is a specific disease very different from peritoneal or ovarian endometriosis. A more precise term is rectovaginal adenomyosis. Radical laparoscopic excision is needed. Although simple this is demanding pelvic surgery, the results are gratifying. The use of a laser seems superior to dissection technique.