Faculty Bibliography

OBJECTIVE:Demonstrate a successful laparoscopic removal of endometriosis from within the inguinal canal via a step-by-step video explanation, underscore the importance of pre-operative MRI imaging, and provide education on anatomy and surgical technique. DESIGN/METHODS:Video case presentation of a successful laparoscopic removal of endometriosis from within the inguinal canal. SUBJECTS/METHODS:A single patient with MRI imaging revealing endometriosis invasion into the inguinal canal and local vasculature. The patient included in this video gave consent for publication of the video and posting of the video online including social media, the journal website, scientific literature websites (such as PubMed, ScienceDirect, Scopus, etc.) and other applicable sites. EXPOSURE/METHODS:The patient's abdomen was entered and vasculature was identified to prevent major bleeding. Appropriate exposure was achieved by transecting the round ligament to provide a landmark for the inguinal canal. The endometriosis was identified and dissected off the external iliac vasculature and the abdominal wall using the squeeze technique. The endometriosis was then dissected out of the inguinal canal, off the femoral artery, and then removed from the abdomen. Post-operatively, the patient was started on norethindrone acetate to suppress any residual disease and prevent recurrence. MAIN OUTCOME MEASURE/METHODS:Patient's pain and quality of life post-operatively. RESULTS:The patient noted immediate pain relief in the recovery room. One year post-operatively, the patient continued to endorse pain relief and no signs of hernia. CONCLUSION/CONCLUSIONS:Inguinal canal endometriosis is of rare occurrence. It typically presents as a groin lump or pain that is worse with menstruation. As the endometriosis is in close proximity to the abdominal wall and local vasculature, MRI imaging, as well as general surgery and vascular surgery consultation, are necessary for proper surgical planning. These are difficult operations that require proper understanding of pelvic and inguinal canal anatomy.

Given the complexities and controversies that exist in diagnosing adult endometriosis, as well as optimizing medical and surgical management, it is not surprising that there is even more ambiguity and inconsistency in the optimal surgical care of endometriosis in the adolescent. This collaborative commentary aimed to provide evidence-based recommendations optimizing the role of surgical interventions for endometriosis in the adolescent patient with input from experts in minimally invasive gynecologic surgery, pediatric and adolescent gynecology, and infertility/reproductive medicine.