6.1 Laparoscopic tools and materials used

In cases in which impaired renal function is known or suspected, static and dynamic renal scintigraphy should be ordered, and endoscopic investigation (ureteroscopy)

Preoperative cystoscopy to evaluate bladder endometriosis is necessary especially when a non-invasive imaging method (MRI or ultrasonography) identifies lesions which are suspicious for endometriosis in the compartment anterior to the uterus. In the cases of lesions infiltrating the bladder mucosa, it is important to determine the exact location(s), their size and their distance from the two ureteral

Such findings could help determine which surgical approach should be used; options range from simple ureterolysis to ureterectomy with uretero-ureteral anastomosis or a ureterovesical reimplantation. Concomitant cystoscopy with vaginal palpation is important to assess disease or areas of adhesions localized in the vesico-

It is advisable to perform outpatient urinary sediment (EAS) and urine culture

Antimicrobial prophylaxis should be administrated during the induction of anesthesia. Thromboembolic prophylaxis of the lower extremities with compressive

Endometriosis infiltrating the bladder trigone and right ureteral ostium as visualized during cystoscopy.

Treatment of endometriosis should be individualized. The laparoscopic approach, robot-assisted or not, has become the option o choice for most sur-

geons [8, 9]. We observed that through accumulated experience and continuous training, it becomes possible to carry out increasingly complex cases laparoscopically, affording the patient all the advantages and benefits of

studies preoperatively to ensure sterile urine during the procedure.

uterine septum that may suggest the need for partial cystectomy or suture-

contemplated to inform surgical planning.

Recent Advances in Laparoscopic Surgery

reinforced bladder shaving (Figure 3).

5. Preoperative preparation

Figure 3.

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6. Surgical treatment

minimally invasive techniques.

or pneumatic stockings is also recommended.

ostia, as well as any projection into the ureter intramurally.

The basic laparoscopic surgical tools required include non-traumatic grasping forceps, Maryland forceps, laparoscopic scissors, laparoscopic needle holders and contra-need holders, as well as an articulating Hook with monopolar cautery. No special clamps are required for this procedure. Bipolar or ultrasonic clamps when available will help with the dissection and hemostasis, reducing surgical time.

Contemplating the possibility of a joint intervention – laparoscopy and cystoscopy/ureteroscopy – a cystoscope, ureteroscope, hydrophilic guidewire, and ureteral catheter should be available. If there is more intense manipulation or segmental resection of the ureter, double J catheter placement will be necessary, in order to ensure a patent ureter and adequate healing. It is worth mentioning that inoperative dynamic C-arm fluoroscopy should be available to verify proper positioning of the catheters.
