Mr Ashwini K Trehan MBBS, DRCOG, FRCOG, FRCS (Edin)

Consultant Minimal Access Gynaecologist

(with special interest in Endometriosis and Keyhole Surgery)

Video showing the Technique of Bowel and Ureter excision in Total Peritoneal Excision Operation

The video features a young patient with severe (stage 4) rectovaginal endometriosis with extensive adhesions on the reproductive organs. The patient suffers from chronic pelvic and bowel pain. In addition, this patient is infertile and seeks fertility.

This video demonstrates the technique of excision (peeling) of endometriois form the surface of the ureters (tubes carrying urine to the bladder), large bowel and other pelvic organs.

To prevent the formation of adhesions and to correct the anatomy of the tilted uterus, a ventrosuspension is undertaken at the end of the operation. Finally blue dye is used to check if the fallopian tubes are open to accept eggs.

This type operation can last upto 8 hours (duration depends on the severity of the endometriosis). Mr Trehan undertakes all major gynaecological procedures, this one included via keyhole means. Patients are fit to leave the hospital the day after the surgery (ie. one night's hospital stay). Mr Trehan's complication rates are amongst the lowest reported in the literature.