Management of a Vaginal Cuff Endometrioma and Ovarian Remnant After Hysterectomy and Bilateral Salpingo-Oophorectomy: A Combined Gynecologic and Colorectal Surgical Approach

INTRODUCTION: This video demonstrates the diagnosis and management of a vaginal cuff endometrioma and ovarian remnant after hysterectomy and bilateral salpingo-oophorectomy. OBJECTIVE: Highlight the tools to aid in diagnosis of a vaginal cuff endometrioma and highlight the surgical techniques for removal using a combined gynecologic and colorectal surgical approach. METHODS: Prior to docking of the robot patient had 5 French ureteral stents placed. Our video demonstrates a robotic-assisted laparoscopic lysis of adhesions and excision of endometrioma involving both gynecology and colorectal surgery. RESULTS: The patient was discharged home on the day of surgery, had an uncomplicated postoperative course, and is no longer experiencing pelvic pain. CONCLUSIONS: In patients with recurrent pelvic pain after hysterectomy and bilateral salpingo-oophorectomy for endometriosis, consideration should be given to ovarian remnant syndrome or persistent deep infiltrating endometriosis. The treatment of choice is surgical excision, which can be successfully accomplished with a robotic approach and a multidisciplinary team.