SIGMOID ENDOMETRIOSIS: WHEN SEGMENTAL RESECTION IN LARGE LESIONS WITH LATERAL-LATERAL ANASTOMOSIS ASSISTED BY ROBOT CAN BE A GOOD OPTION

Case Presentation A 39-year-old woman presented with colicky pain around her menstrual period, in addition to infraumbilical abdominal pain associated with an increased frequency of bowel movements from 1 to 3 times a day and dyspareunia. The patient desired to have children. Transvaginal ultrasound with preparation revealed, in addition to ovarian and deep pelvic peritoneal involvement, a lesion in the sigmoid colon that was not contiguous with the previous lesions. A robotic approach was chosen, and resection of peritoneal endometriosis foci, ureterolysis, and resection of the uterosacral ligaments were performed. The evaluation of the lesion above the rectosigmoid transition showed that it was larger than 4 cm and invaded the muscular layer, so a segmental resection of the sigmoid of approximately 7 cm was performed. The dissection of the mesocolon with the robotic arms was done near the loop without ligating more proximal vessels, without compromising irrigation. A mechanical isoperistaltic lateral-lateral anastomosis was then performed using a linear stapler. Highlights included the optical stability, providing better vision, and the increased precision of movements. The patient had an excellent postoperative recovery, with bowel movement on the first day and discharge on the second. Intestinal function returned to normal shortly after the surgery.

Discussion The intestine is a common site of involvement in deep endometriosis, which causes significant anxiety for patients and gynecologists due to uncertainties about management, function, and especially the need for a stoma. About 10% of patients with endometriosis have intestinal involvement, with the sigmoid colon being the second most affected segment, involved in 25% of cases, second only to the rectum (80%). Because the sigmoid wall is narrower and the stool consistency is solid in this segment, more extensive tangential resection is generally avoided. Furthermore, partial sigmoid resection does not compromise function. This case demonstrates an economical segmental resection tailored to the extent of the intestinal lesion and highlights the precision of robotic surgery, encouraging greater diffusion of this technique for addressing a challenging, multidisciplinary disease that can greatly benefit young patients. The robotic approach is still rarely practiced in Brazil for such a complex disease and should be more widely promoted.

Conclusion This video demonstrated the importance of robotic-adjusted segmental sigmoid resection with lateral-lateral anastomosis. The technique proved to be safe and teachable, making it a valuable tool for spreading knowledge.

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

Publication History

Article published online:
25 April 2025