Six-Step-Strategy for ureterolysis and adhesiolysis for an Obliterated Cul-de-sac- Double Bipolar method in Robotic Assisted surgery -

Study Objective To show a procedure of ureterolysis and adhesiolysis for Obliterated Cul-de-sac as a result of endometriosis. Design Step-by-step video demonstration of the surgical procedure. Setting Urban general hospital. Da Vinci Xi, Cutting device is Maryland bipolar forceps and connected with a specific energy platform at macromode 60W. Patients or Participants N/A. Interventions We have the following Six-Step-Strategy. 1. Mobilize the uterus to the anterior side with the uterine manipulator and mobilize the rectum to the cranial side to make clear the dissecting line in the adhesion between the uterus and rectum. This step is performed by the patient-side surgeon or the robotic arm. 2. Dissect the median area of the adhesion with Maryland forceps 3. Confirm the point where the ureters cross over the common iliac artery and perform ureterolysis near the adhered area. With our Double-Bipolar method, Maryland forceps can make this procedure much easier because we can grasp tissue and dissect adhesion with both blunt and sharp dissection. 4. Dissect the pararectal space and confirm the contour of the rectum. 5. Perform adhesiolysis extending to the Cul-de-sac and open the rectovaginal space. 6. Confirm whether or not rectal injuries have occurred with the air leak test. Measurements and Main Results N/A. Conclusion With this Six-Step-Strategy and Double Bipolar method, adhesiolysis and ureterolysis an Obliterated Cul-de-sac as a result of endometriosis can be performed safely and precisely in a Robotic-Assisted surgery session.