Kiyohiko Yamada
Tsujinaka Hospital, JapanPresentation Title:
Resection of the median pelvic endometriosis through a trapezoidal incision in the peritoneum of the retrocervix and posterior vaginal fornix
Abstract
Objective: To describe laparoscopic surgical procedure for the resection of the median pelvic endometriosis (RME), and to verify relief and recurrence of pain symptoms through RME.
Materials and Methods: Under the diagnosis of the endometrioid cyst, 885 patients underwent laparoscopic surgery. Pelvic pain was assessed using a 10-cm visual analogue scale (VAS). Four hundred and nineteen patients (47%) underwent the RME. The patients were classified into 3 groups (mild, moderate, severe) according to the severity of pain symptoms. Following adhesiolysis if necessary, a trapezoidal incision was made to the pelvic peritoneum on the retrocervix and posterior vaginal fornix, and the fibrotic lesion beneath the incision was resected. Recurrence was judged when the patients were presented with pelvic pain postoperatively.
Results: The pelvic endometriotic lesions were mainly attached on the trapezoidal area of the posterior vaginal fornix and retrocervical region in the cul-de-sac. Pelvic organs gathered and adherent to this endometriotic lesion. The pelvic endometriosis was removed without serious damages to the rectum or vaginal wall through RME from this area. he RME improved postoperative pain symptoms more effectively in the surgery of the endometrioid cyst. Recurrence of pain symptoms occurred in 20% of patients. Recurrence rates were higher in patients of moderate to severe symptoms.
Conclusions: The pelvic endometriotic lesion could be removed from the retrocervix and posterior vaginal fornix by a trapezoidal incision in the pelvic peritoneum through the RME without significant complications. Pelvic pain reduced more effectively through the laparoscopic surgical RME.
Biography
Kiyohiko Yamada was born in Japan. He graduated from Gunma University School of Medicine and completed postgraduate studies there. From 1986 to 1988, as an Alexander von Humboldt Research Fellow, he conducted pioneering research in fertilization through sperm injection into oocyte under Prof. Mettler at Kiel University Hospital in West Germany. Following his fellowship, he held positions at Gunma University Hospital and the Japanese Red Cross Maebashi Hospital, refining his expertise in gynecological surgery. Over his career, he has performed approximately 6,000 laparoscopic procedures, focusing extensively on endometriosis-related pain management. During this time, he served as a symposium speaker at various academic conferences and received prestigious awards in recognition of his contributions. Currently practicing at Tsujinaka Hospital Kashiwanoha, he continues to advance surgical techniques and research into effective treatments for endometriosis. His dedication to minimally invasive gynecological surgery and improving patient outcomes has positioned him as a leader in the field.
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