Deep rectal shaving followed by transanal disc excision in large deep endometriosis of the lower rectum

Abstract

Study objective: To report an original technique of deep rectal shaving using PlasmaJet (Plasma Surgical, Inc., Roswell, GA) followed by transanal disc excision using the Contour Transtar stapler (Ethicon EndoSurgery Inc., Cincinnati, OH) suitable in large deep endometriosis of the lower rectum.

Design: Canadian Task Force III.

Setting: Rouen University Hospital. The procedure was performed in a 30-year-old nullipara referred with a large endometriotic nodule infiltrating the right uterosacral ligament and the anterolateral wall of the lower rectum. Rectal infiltration measured 30 mm in diameter and was responsible for stenosis. The first step of the procedure is represented by laparoscopic deep rectal shaving performed using plasma energy exclusively, combining the detachment of the nodule from the rectum with in situ ablation of residual endometriotic foci of the shaved area. Then, transanal excision is performed by the colorectal surgeon from the rectal approach. Three of 4 traction parachute sutures are placed in the middle and outside the shaved area. Their traction induces the prolapse of the shaved rectal wall that is resected using the Contour Transtar stapler, which is a device originally destined to remove rectal prolapse. The final staple line is inspected for bleeding and secured with an interrupted resorbable suture as required. Surgical technique reports in anonymous patients are exempt from ethical approval by an institutional review board.

Intervention: Deep rectal shaving using PlasmaJet followed by transanal disc excision using Contour Transtar stapler.

Measurements and main results: Immediate postoperative outcomes were uneventful, and bowel movements were normal beginning with day 5. To date, this procedure was successfully performed in 17 women with large deep endometriosis of the mid and lower rectum with only favorable rectal functional outcomes.

Conclusions: Based on our experience, we believe that our conservative technique is feasible in large low rectal endometriosis and avoids the risk of unfavorable outcomes related to low colorectal resection.

Keywords: Deep endometriosis; Disc excision; Plasma energy; Rectal endometriosis; Rectal shaving.