Evaluation of the Feasibility and Contribution of Multifaceted Ultrasound in the Operating Room to Facilitate the Shaving Technique in the Treatment of Rectal Endometriosis

STUDY OBJECTIVE: To evaluate the feasibility and potential contribution of preoperative and intraoperative ultrasound in rectal shaving, to support surgical decision-making and achieve optimal lesion excision. DESIGN: A prospective, single-center cohort study was conducted in the Lille University Hospital, France from March 2023 to July 2024 SETTING: Colorectal involvement is the most common form of extra-gynecological endometriosis which affects 5 to 12% of women with deep endometriosis. Three surgical management strategies are commonly employed: rectal shaving, discoid excision, and segmental resection. The latter, although associated with lower morbidity, carries a risk of incomplete excision, with reported recurrence rates ranging from 7% to 24%. Transvaginal ultrasound is validated for lesion mapping, but intraoperative ultrasound assessment of the completeness of rectal shaving remains scarcely investigated. PATIENTS: Women with deep endometriosis infiltrating bowel, and who are symptomatic despite medical therapy, for whom rectal shaving was planned. MEASUREMENTS AND MAIN RESULTS: All patients underwent a preoperative transvaginal ultrasound with fluid instillation to confirm bowel involvement and assess the depth of infiltration. Intraoperative rectal ultrasound was then also performed after nodule removal to detect any residual lesions. If no residual disease was seen, the procedure was considered complete; otherwise, additional excision was performed, either by extended shaving or discoid resection. Among the 10 patients, intraoperative rectal ultrasound confirmed complete excision in 5 cases and led to further resection in 5 cases (4 additional shavings and 1 discoid resection). Histopathological examination confirmed endometriosis in all additional resections following intraoperative rectal ultrasound. CONCLUSION: Intraoperative rectal ultrasound appears to be a valuable and feasible tool to assess resection completeness during rectal shaving. It may help avoid unnecessary bowel resections, reduce perioperative morbidity, and potentially lower recurrence rates in the conservative surgical management of rectal endometriosis.