Techniques for Pelvic Organ Suspension During Excision of Endometriosis

INTRODUCTION: Surgical management of advanced endometriosis requires effective exposure of the pelvic organs to facilitate a safe and effective excision. Pelvic organ suspension techniques provide the means of optimizing the surgical field while minimizing the need for additional assistants and retraction. There are both temporary and permanent methods in safely suspending the ovaries, fallopian tubes, uterus, and sigmoid colon. Despite their utility, the range of suspension strategies and their specific applications are not well described in the current literature. OBJECTIVE: The objective of this video is to describe various techniques for suspension of the ovaries, fallopian tubes, sigmoid colon, and uterus. It further demonstrates applications of both temporary and permanent suspension techniques during excision of endometriosis. METHODS: Educational video highlighting surgical techniques. RESULTS: We highlight specific surgical techniques including 1) temporary oophoropexy to the lateral abdominal wall, 2) oophoropexy to the round ligament, 3) temporary suspension of the sigmoid colon, 4) temporary oophoropexy to the anterior abdominal wall, 5) temporary suspension of the uterus and adnexa to the anterior abdominal wall, and 6) transmesosalpingeal adnexal suspension. The selection of the appropriate technique depends on several factors, including desire for hands-free retraction, presence or absence of fallopian tubes, risk of adhesion formation following extensive retroperitoneal dissection, and inability to use a manipulator. CONCLUSIONS: We have demonstrated a variety of techniques for temporary and permanent suspension of pelvic organs during endometriosis excision. Selection of these techniques may improve visualization during complex endometriosis excision. Furthermore, selection of certain techniques may provide additional benefits of preventing the ovaries from adhering to the pelvic sidewalls postoperatively and preventing ovarian torsion.