RECTAL ENDOMETRIOSIS: PARTICULARITIES OF SHAVING RESECTION VIA LAPAROSCOPY AND ROBOTICS

Case Presentation These are two cases of deep rectal endometriosis. Both patients have similar clinical histories, experiencing cyclical abdominal pain during menstruation and discomfort with bowel movements. The first, a 28-year-old woman with uterine fibroids and a desire for reproduction, and the second, a 40-year-old woman with completed family, whose symptoms began after childbirth. The first case was approached laparoscopically, and the lesion was adhered to the uterine torus. After myomectomy, the approach was initially to release the lesion from the rectovaginal septum by dissecting the lateral regions, addressing the Okabayashi space to avoid injury to adjacent structures. Subsequently, the rectal lesion was dissected initially at its edges, isolating it from the mesorectum. Dissection was continued along the rectal muscle layer using low-voltage electrocautery (15), in pure cut mode, with a hook. After the resection of the lesion, rectal integrity was confirmed, and no residual lesions were noted. The blow test was performed, and the serosa was closed with transverse sutures. In the second case, the robotic approach was chosen. After subtotal hysterectomy, the rectal lesions were not directly connected to the rectovaginal septum. Circumferential isolation of the lesions was performed with a robotic scissors in low voltage, in cut mode. The lesions were then detached from the rectal muscle and sutured transversely. The blow test was negative. The main advantage of the robotic approach was the stability of the optics, providing better visibility and precision in movements.

Discussion Deep endometriosis is characterized by the involvement of the peritoneal surface at a depth greater than 4 mm. Rectal involvement occurs in about 10% of cases of endometriosis and requires the approach of a colorectal specialist. The rectum is an essential organ for continence and intestinal function, and whenever possible, it should be preserved. Tangential resection (shaving) of the rectal wall is an ideal option when attempting to preserve the rectum in endometriosis surgeries. About 10 years ago, robotic surgery was introduced to optimize the precision and success of these procedures. However, to date, the results of both techniques are comparable.

Conclusion The key importance of this video is to detail the shaving resection technique, regardless of the approach used, in order to spread the technique and encourage more surgeons to consider rectal function preservation in cases of identifiable endometriosis.

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

Publication History

Article published online:
25 April 2025