Deep shaving and transanal disc excision in large endometriosis of mid and lower rectum: the Rouen technique

Horace Roman, Carole Abo, Emmanuel Huet, Jean-Jacques Tuech, Jean‐Jacques Tuech
Surgical endoscopy · 2015 · vol. 30(6) , pp. 2626–2627 · doi:10.1007/s00464-015-4528-8 · PMID:26423408 · W2173804097
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-07 ⓘ

This study describes and validates the Rouen technique, combining laparoscopic deep rectal shaving with transanal disc excision, for treating large mid and lower rectal endometriosis, showing feasibility and improved digestive function in 29 patients.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 · read from full text ⓘ

The paper describes a surgical approach for large deep endometriotic nodules infiltrating the mid and lower rectum, using laparoscopic deep rectal shaving with plasma energy followed by transanal disc excision with a semicircular stapler. In a 29-year-old woman (and subsequently a series of 29 women) selected by preoperative MRI/CT criteria (mid/lower rectal location up to 10 cm above the anus, rectal infiltration up to 6 cm length), the authors report operative time of 210 minutes and uneventful immediate postoperative outcomes, with bowel movements normal by day 6 and overall improved digestive function without new anal continence problems. Complications included one rectovaginal fistula (3.6%) and transitory bladder dysfunction in seven patients (25%), and pregnancy occurred in 78% of patients with most conceiving spontaneously. This paper is centrally about endometriosis — it presents the “Rouen technique” for conservative management of large mid/lower rectal deep endometriosis.

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Abstract

Background Colorectal resection is performed in a majority of patients presenting with large endometriosis of mid and lower rectum; however, it may negatively and irreversibly impact postoperative rectal function. To avoid such unfavourable outcomes, we propose an original technique combining laparoscopic deep rectal shaving and transanal disc excision using a semi-circular stapler.

Methods

The video presents the procedure performed in a 29-year-old nullipara referred with a large endometriotic nodule infiltrating the lower rectum on more than 30 mm length. The first step is laparoscopic and involves deep rectal shaving performed using exclusively the plasma energy. Then, transanal excision of shaved area is performed, by placing traction parachute sutures in the middle and outside the shaved area. Their traction induces the prolapse of shaved area that is resected using a semicircular stapler. Insufflating the rectum with air checks the integrity of the staple line.

Results

Operative time was 210 min. Immediate postoperative outcomes were uneventful, and bowel movements were normal beginning with day 6. Our technique is suitable in large rectal nodules located up to 10 cm above the anus, infiltrating the rectum on up to 6 cm length, and these parameters are preoperatively assessed using MRI and computed tomography. To date, it was successfully carried out in 29 women with large deep endometriosis of the mid and lower rectum. Rectovaginal fistula was recorded in one patient (3.6 %) and transitory bladder dysfunction in seven patients (25 %). Digestive function assessment using standardized questionnaires revealed an overall improvement, without de novo anal continence troubles. Postoperative pregnancy rate was 78 % with a majority of patients having conceived spontaneously.

Conclusions

Based on our experience, we believe that our conservative technique is feasible and reproducible in large mid and lower rectal endometriosis and might avoid the risk of unfavourable outcomes related to low colorectal resection. Similar content being viewed by others

References

Roman H, Bridoux V, Tuech JJ, Marpeau L, da Costa C, Savoye G, Puscasiu L (2013) Bowel dysfunction before and after surgery for endometriosis. Am J Obstet Gynecol 209:524–530 Roman H, Vassilieff M, Bridoux V, Resch B, Marpeau L, Tuech JJ (2013) Postoperative digestive function after radical versus conservative surgical philosophy for deep endometriosis infiltrating the rectum. Fertil Steril 99:1695–1704 Minelli L, Fanfani F, Fagotti A, Ruffo G, Ceccaroni M, Mereu L, Landi S, Pomini P, Scambia G (2009) Laparoscopic colorectal resection for bowel endometriosis: feasibility, complications, and clinical outcome. Arch Surg 144:234–239 Daraï E, Dubernard G, Coutant C, Frey C, Rouzier R, Ballester M (2010) Randomized trial of laparoscopically assisted versus open colorectal resection for endometriosis: morbidity, symptoms, quality of life, and fertility. Ann Surg 251:1018–1023 Bridoux V, Roman H, Kianifard B, Vassilieff M, Marpeau L, Michot F, Tuech JJ (2012) Combined transanal and laparoscopic approach for the treatment of deep endometriosis infiltrating the rectum. Hum Reprod 27:418–426 Roman H (2013) Deep shaving using PlasmaJet in deep endometriosis of the rectum. Fertil Steril 100:e33 Slim K (1999) First validation of the French version of the Gastrointestinal Quality of Life Index (GIQLI). Gastroenterol Biol Clin 23:25–31 Knowles CH, Scott SM, Legg PE, Allison ME, Lunniss PJ (2002) Level of classification performance of KESS (symptom scoring system for constipation) validated in a prospective series of 105 patients. Dis Colon Rectum 45:842–843 Author information Authors and Affiliations Corresponding author Ethics declarations Disclosures Horace Roman reports personal fees for participating in a symposium and a masterclass presenting his experience in the use of PlasmaJet. Carole Abo has no conflict of interest. Emmanuel Huet has no conflict of interest. Jean-Jacques Tuech has no conflict of interest. Electronic supplementary material Below is the link to the electronic supplementary material. Supplementary material 1 (MOV 130,774 kb) Rights and permissions About this article Cite this article Roman, H., Abo, C., Huet, E. et al. Deep shaving and transanal disc excision in large endometriosis of mid and lower rectum: the Rouen technique. Surg Endosc 30, 2626–2627 (2016). https://doi.org/10.1007/s00464-015-4528-8 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00464-015-4528-8

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Condition tags

mesh:D004715endometriosis

MeSH descriptors

Ablation Techniques Endometriosis Proctoscopy Rectal Diseases Surgical Stapling Ablation Techniques Ablation Techniques Adult Endometriosis Female Humans Laparoscopy Rectal Diseases Rectum Rectum Surgical Staplers Surgical Stapling Surgical Stapling Suture Techniques

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