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CC BY 4.0 · Journal of Coloproctology 2024; 44(S 01): S1-S138
DOI: 10.1055/s-0045-1808805
Temas Gerais Dentro da Especialidade
General Topics Within the Specialty
ID – 137926
E-poster

SURGERY FOR SPECIMEN EXTRACTION VIA NATURAL ORIFICE (NOSES) DURING LAPAROSCOPY FOR DEEP INFILTRATIVE ENDOMETRIOSIS INVOLVING THE RECTUM

Rogerio Serafim Parra
1   Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Brazil
,
Gabriela Oliveira Bagano
1   Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Brazil
,
Daniela França Camargo Freitas
1   Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Brazil
,
Fernando Passador Valério
1   Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Brazil
,
José Vitor Cabral Zanardi
1   Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Brazil
,
Omar Féres
1   Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Brazil
,
José Joaquim Ribeiro da Rocha
1   Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Brazil
,
Marley Ribeiro Feitosa
1   Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Brazil
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    Introduction Deep endometriosis is one of the most severe forms of endometriosis, and in up to 25% of cases, it can affect the intestine. The lesions may be either single or multifocal, and depending on the affected anatomical site, they can cause symptoms ranging from dysmenorrhea to dyspareunia and rectal bleeding.

    Objective To describe the surgical technique of Natural Orifice Specimen Extraction Surgery (NOSES) during laparoscopy for deep infiltrative endometriosis involving the rectum.

    Methods A 38-year-old patient with abnormal uterine bleeding and chronic pelvic pain, refractory to clinical treatment and with no desire for pregnancy, was evaluated. Preoperative imaging exams identified a lesion in the uterine torus, extending to the insertion of both sacrouterine ligaments (LUS), measuring 4.1x1.0x1.7 cm. On the anterior wall of the rectum, about 12 cm from the anal edge, there was a 4.4x1.1x1.9 cm nodule reaching the inner layer, occupying 35% of the circumference, adhered to the uterine torus. The surgery was performed laparoscopically, and the procedure included total hysterectomy, removal of the fallopian tubes, resection of the lesions on the uterine torus and LUS, appendectomy, and segmental resection of the rectum with specimen removal via the vagina.

    Discussion NOSES surgery can be offered to patients with deep endometriosis requiring segmental resection of the rectum and/or appendectomy. The passage of the laparoscopic linear stapler for appendectomy is done through the already opened vagina (in cases of laparoscopic hysterectomy or intentional or accidental vaginal opening). The removal of the rectal segment can be done vaginally when the vagina is already open. This approach improves postoperative pain, minimizes the chances of hernias, and reduces the risk of abdominal wall infections at the site of specimen extraction.


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    No conflict of interest has been declared by the author(s).

    Publication History

    Article published online:
    25 April 2025

    © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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