Tips for navigating the altered retroperitoneum

Brought to you by the Society of Gynecologic Surgeons. In this video, the authors illustrate strategies to safely navigate the fibrotic, distorted retroperitoneum due to stage IV endometriosis. Techniques of “push and spread” and “tunnel and bridge” are demonstrated to help overcome obliteration of normal tissue planes. The video also highlights the importance of starting with normal anatomy, using the ureter as a guide in the retroperitoneum, and maximizing tension while minimizing heat to protect underlying structures. Even the most difficult dissections can be safely accomplished with these techniques.