Laparoscopic Mesentery-sparing NOSE Bowel Resection for Endometriosis: When and How?

OBJECTIVE To describe the peri-operative considerations and surgical steps for a laparoscopic segmental resection for colorectal endometriosis, using a nerve-sparing, mesentery-sparing and natural orifice specimen extraction technique1-3. DESIGN Narrated surgical video within a tertiary care hospital. IRB approval was not necessary for this article in accordance with the Tri-Council Policy Statement of Canada, article 2.5. SUBJECTS Recorded case of a 5-cm deep rectal nodule requiring resection. EXPOSURE Laparoscopic segmental resection. MAIN OUTCOME MEASURES Overview of bowel endometriosis, surgical approaches, peri-operative care and surgical steps. RESULTS The surgical approach is illustrated in eight steps: (1) mobilization of the adnexa and cul-de-sac; (2) bilateral ureterolysis; (3) dissection of the pararectal and rectovaginal spaces; (4) mesenteric dissection +/- sigmoid mobilization; (5) enterotomies and anvil placement; (6) segmental resection and natural orifice specimen extraction; (7) re-anastomosis; (8) rigid sigmoidoscopy. Peri-operative care should align with the ERAS pathway for colorectal surgery4. CONCLUSION In cases of multi-organ endometriosis, gynecologic surgeons must remain at the forefront of clinical decision making and surgical care coordination. The standardization of the surgical approach allows for a safe and reproducible performance of the intervention.