Partial Cystectomy for Deeply Infiltrating Endometriosis of the Bladder with Cystotomy Repair

Video Objective To demonstrate safe surgical technique and management of partial bladder cystectomy and simple cystotomy repair due to deeply infiltrating endometriosis (DIE) using the Xi DaVinci robot. Setting A 32yo patient with dysmenorrhea and dyspareunia found to have DIE of the bladder undergoing surgical management at a large academic center. Interventions The bladder lesion was initially found on preoperative MRI and confirmed during robotic assisted surgery. The lesion was felt to be full thickness and required partial bladder cystectomy for adequate excision of the implant. The DaVinci robot was used to remove the lesion with good margins. The resulting cystotomy repair was repaired, with good seal noted when the bladder was backfilled and on cystoscopy. A foley catheter was maintained for 7 days postoperatively and removed after a cystogram showing adequate bladder recovery. Conclusion Deeply infiltrating endometriosis of the bladder is rare but can be safely managed with laparoscopic partial bladder cystectomy and cystotomy repair. Adequate preoperative planning and thorough inspection of the lesion during surgery can assist with full removal of the lesion, which improves patient symptoms and decreases incidence of recurrence.