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Excision of abdominal wall endometriosis: Surgical technique in an obese patient with a 5-cm abdominal nodule.

Endometriosis, defined by the ectopic growth of functioning endometrial glands and stroma, (1,2) usually affects the peritoneal cavity. However, endometriosis has been identified in the pneumothorax, brain, and within the extraperitoneum, such as the abdominal wall. (1-3) Incidence of abdominal wall endometriosis can be up to 12%. (3-5) If patients report symptoms, they can include abdominal pain, a palpable mass, pelvic pain consistent with endometriosis, and bleeding from involvement of the overlying skin. Abdominal wall endometriosis can be surgically resected, with complete resolution and a low rate of recurrence.

In the following video, we review the diagnosis of abdominal wall endometriosis, including our imaging of choice, and treatment options. In addition, we illustrate a surgical technique for the excision of abdominal wall endometriosis in a 38-year-old patient with symptomatic disease. We conclude with a review of key surgical steps.

We hope that you find this video useful to your clinical practice.

DR. ARNOLD P. ADVINCULA, AND COLLEAGUES

To view the video

Visit Arnold Advincula's Surgical Techniques Video Channel in the Multimedia Library at mdedge.com/obgyn or use the QR code

Dr. Arora is Minimally Invasive Gynecologic Surgery Fellow, Division of Gynecologic Specialty Surgery, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York.

Dr. Mattingly is Program Director, Minimally Invasive Gynecologic Surgery, Novant Health Pelvic Health & Surgery, Charlotte, North Carolina.

Dr. Advincula is Levine Family Professor of Women's Health; Vice-Chair, Department of Obstetrics & Gynecology; Chief of Gynecology, Sloane Hospital for Women; and Medical Director, Mary & Michael Jaharis Simulation Center, Columbia University Irving Medical Center, New York-Presbyterian Hospital. He serves on the OBG Management Board of Editors.

Dr. Kim is Assistant Professor of Obstetrics and Gynecology, Division of Gynecologic Specialty Surgery, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center/New York-Presbyterian Hospital.

Dr. Arora reports receiving grant or research support from Applied Medical, CooperSurgical, and Medtronic (in-kind equipment grant).

Dr. Mattingly reports no financial relationships relevant to this video.

Dr. Advincula reports serving as a consultant to AbbVie, ConMed, CooperSurgical, Intuitive Surgical, and Titan Medical and receiving royalties from CooperSurgical.

Dr. Kim reports serving as a consultant to AbbVie and Intuitive Surgical.

References

(1.) Burney RO, Giudice LC. Pathogenesis and pathophysiology of endometriosis. Fertil Steril. 2012;98:511-519.

(2.) Ecker AM, Donnellan NM, Shepherd JP, et al. Abdominal wall endometriosis: 12 years of experience at a large academic institution. Am J Obstet Gynecol. 2014;21 l:363.el-e5.

(3.) Horton ID, Dezee KJ, Ahnfeldt EP, et al. Abdominal wall endometriosis: a surgeon's perspective and review of 445 cases. Am J Surg. 2008:196:207-212.

(4.) Ding Y, Zhu J. A retrospective review of abdominal wall endometriosis in Shanghai, China. Int J Gynaecol Obstet. 2013;121:41-44.

(5.) Chang Y, Tsai EM, Long CY, et al. Abdominal wall endometriosis. J Reproductive Med. 2009;54:155-159.
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Title Annotation:VIDEO CHANNEL
Author:Arora, Chetna; Mattingly, Patricia J.; Advincula, Arnold P.; Kim, Jin Hee
Publication:OBG Management
Date:Jun 1, 2019
Words:472
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