Sinha Rooma, Singh Sukhbir, Flaxman Teresa
Department of Gynaecology and Robotic Surgery, Apollo Hospitals, Hyderabad, Telangana, India.
Macquarie University, Sydney, Australia.
Case Rep Obstet Gynecol. 2025 May 27;2025:5513823. doi: 10.1155/crog/5513823. eCollection 2025.
Extensive and infiltrative fibrous adhesions of the uterus and ovaries to the surrounding organs make surgical interventions in endometriosis challenging. A preoperative identification of these involvements can help the surgeon better prepare for the surgery. Traditionally, ultrasonography and magnetic resonance imaging (MRI) have been used. However, clinical use of modern VR technology for creating and visualising a three-dimensional (3D) digital model for a complex surgical case has been proposed. We describe a case of a 29-year-old who presented with dyspareunia and dysmenorrhea (VAS score of 10/10) with left parametrial endometriosis and created a 3D model from their two-dimensional (2D) DICOM images. A left parametrial endometriosis nodule was identified involving the left ureter, rectum, and vaginal fornix along with mucosa. A virtual preoperative surgery was done for precise and complete excision of the disease and to prevent injury to the left ureter and rectum. The surgery was performed as a two-step excision using a da Vinci Xi robot and included left ureterolysis, shaving of the bowel endometriosis nodule and full-thickness vaginal wall excision along with the infiltrating nodule. The infiltrating endometriosis nodule was split into two halves and was excised individually. Her postoperative VAS score for dysmenorrhea was 2/10, and she is 28 weeks pregnant at the time of submission. Advanced VR imaging can help in the evaluation and management of deep endometriosis. It can improve the surgeon's understanding of the specific anatomy, visualise the disease, and improve clinical outcomes.
子宫和卵巢与周围器官广泛且浸润性的纤维粘连使得子宫内膜异位症的手术干预具有挑战性。术前识别这些受累情况有助于外科医生更好地为手术做准备。传统上，一直使用超声检查和磁共振成像（MRI）。然而，有人提出将现代虚拟现实（VR）技术临床应用于为复杂手术病例创建和可视化三维（3D）数字模型。我们描述了一例29岁患者，其因左侧宫旁子宫内膜异位症出现性交困难和痛经（视觉模拟评分10/10），并从其二维（2D）DICOM图像创建了一个3D模型。发现一个左侧宫旁子宫内膜异位结节，累及左侧输尿管、直肠和阴道穹窿以及黏膜。进行了虚拟术前手术，以精确、完整地切除病灶，并防止损伤左侧输尿管和直肠。手术使用达芬奇Xi机器人分两步进行切除，包括左侧输尿管松解术、切除肠道子宫内膜异位结节以及全层阴道壁连同浸润性结节一并切除。浸润性子宫内膜异位结节被切成两半并分别切除。她术后痛经的视觉模拟评分为2/10，在提交本文时已怀孕28周。先进的VR成像有助于深部子宫内膜异位症的评估和管理。它可以提高外科医生对特定解剖结构的理解，可视化病灶，并改善临床结果。
