Stepwise approach to the laparoscopic excision of bladder endometriosis.

Objective: To describe a stepwise approach to the laparoscopic excision of bladder endometriosis.

Design: Narrated surgical video.

Setting: Academic tertiary care hospital.

Patient(s): Surgical footage was obtained from three patients who underwent surgery for bladder endometriosis. Institutional review board approval was not required in accordance with the Tri-Council Policy Statement of Canada, article 2.5.

Intervention(s): Laparoscopic excision of bladder endometriotic nodules by partial cystectomy.

Main Outcome Measure(s): Overview of the relevant anatomy, disease overview, surgical planning and perioperative care, and the approach to the excision of bladder endometriotic nodules.

Result(s): The approach to excision of bladder endometriotic nodules can be standardized in six reproducible steps: cystoscopy with or without ureteral stent placement; abdominal survey and treatment of posterior compartment disease; bladder mobilization; partial bladder cystectomy under cystoscopic guidance; cystotomy closure; and water-leak test.

Conclusion(s): The safe and complete excision of bladder endometriosis relies on the understanding of surgical anatomy, the multidisciplinary aspect of patient care, and the standardization of the surgical approach.