Frozen pelvis surgical strategy in ten steps

Abstract Study Objective To describe a ten steps strategy to treat a severe endometriosis with a frozen pelvis by laparoscopy Design Educational Video Setting University Hospital of Strasbourg, France Intervention The patient is a 33 years old nulliparous woman, suffering from endometriosis. Due to pain and a pregnancy desire, she was scheduled for surgery. After setting the patient in gynecological position, we use a uterine manipulator to facilitate exposure. We assess the global situation, discovering a frozen pelvis. To treat the fibrosis, the surgeon should use traction and counter traction, as much as possible. We start with the caecum and sigmoid detachment. Then we perform a bilateral ureterolysis. Once the ureters are identified, we can perform safely the adhesiolysis of the bowel from the uterus. The adnexas can be freed and suspended with a T-Lift device to facilitate exposure. After identifying the utero sacral ligament, we can open the para rectal fossa, leading to the opening of the recto vaginal space. The anatomy is then restored, and we can define the specific surgical strategies. Conclusion Frozen pelvis is a situation where anatomy is distorted. The surgeon should find anatomical landmark in order to restore anatomy and to establish specific strategies adapted to the patient.