Surgical laparoscopic treatment of bowel endometriosis with transvaginal resection of the rectum using ultrasonically activated shears: a retrospective cohort study with description of technique

Background To asses the results of laparoscopic surgical treatment of bowel endometriosis with transvaginal resection of the rectum employing ultrasonic energy retrospective study.

100 patients with symptoms of narrowing or partial obstruction of colon were submitted to laparoscopic resection of rectosigmoid tract through a vaginal route. Length of surgery, blood loss, histopathological extent of rectal invasion, surgical complications, and length of hospital stay were the main analyzed outcomes.

Mean operative time was 281 min, blood loss was 250 ml on average, length of stay was 8 days, bowel movements were after 3.5 days, the mean length of bowel-resected segments was 13.3 cm, the disease was multifocal in 64% and multicentric in 36% of surgical specimens.

Laparoscopically assisted vaginal resection of rectosigmoid colon affected by endometriosis using ultrasonically activated shears with mechanical intestinal anastomoses tension free is a safe and effective procedure for surgical management of severe pelvic endometriosis with bowel involvement. Similar content being viewed by others

Chapron C, Dubuisson JB (2001) Management of deep endometriosis. Ann N Y Acad Sci 943:276–280 Chapron C (1998) Results and role of rectal endoscopic ultrasonography for patient with deep pelvic endometriosis. Hum Reprod 13(8):2266–2270 Possover M, Diebolder H, Plaul K, Schneider A (2000) Laparoscopically assisted vaginal resection of rectovaginal endometriosis. Obstet Gynecol 96:304–307 Ribeiro PA, Rodriguez FC, Kehdi IPA, Rossini L, Abdalla E, Donadio N, Aoki T (2006) Laparoscopic resection of intestinal endometriosis: a 5 year experience. J Min Invasive Gynecol 13:442–446 Kavallaris A, Kohler C, Kuhne-heid R, Schneider A (2003) Histopathological extent of rectal invasion by rectovaginal endometriosis. Hum Reprod 18(6):1323–1327 Redwine DB, Koning M, Sharpe DR (1996) Laparoscopically assisted transvaginal segmental resection of the rectosigmoid colon for endometriosis. Fertil Steril 65(1):193–197 Chapron C, Vieira M, Chopin N, Balleyguier C, Barakat H, Dumontier I, Roseau G, Fauconnier A, Foulot H, Dousset B (2004) Accuracy of rectal endoscopic ultrasonography and magnetic resonance imaging in the diagnosis of rectal involvement for patients presenting with deeply infiltrating endometriosis. Ultrasound Obstet Gynecol 24:175–179 Campagnacci R, Perretta M, Guerrieri M, Paganini M, De Sanctis A, Ciavattini A, Lezoche E (2005) Laparoscopic colorectal resection for endometriosis. Surg Endosc 19(662–66):4 Bartkowiak R, Zieniewic K, Kaminski P, Krawczyk M, Marianowski L, Szymanska K (2000) Diagnosis and treatment of sigmoidal endometriosis—a case report. Med Sci Monit 6(4):787–790 Paulson JD, Alizadeh A, Andrade R (1997) Tratamento da endometriose por laparoscopia operatoria. In: Ueno J, Santos NC, Pinheiro W, Pinotti JA (eds) Chirurgia video endoscopica em ginecologia. Roca, Sao Paulo, pp 134–145 Koninckx PR, Meuleman C, Demeyere C (1991) Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain. Fertil Steril 55(759):765 Varol N, Maher P, Healey M, Woods R, Woods C, Hill D, Lolatgls N, Tsaltas J (2003) Rectal surgery for endometriosis. Should we be aggressive? J Am Assoc Gynecol Laparosc 10(2):182–189 Shaw RW (1992) Treatment of endometriosis. Lancet 340:1267–1271 Chapron C, Bourret A, Chopin N, Dousset B, Leconte M, Amsellem-Ouzana D, Ziegler D, Borghese B (2010) Surgery for bladder endometriosis: long term results and concomitant management of associated posterior deep lesions. Hum Reprod 25:884–889 Faller E, Albornoz J, Messori P, Leroy J, Wattiez A (2013) A new technique of laparpscopic intracorporeal anastomosis for transrectal bowel resection with transvaginal specimen extraction. J Minim Invasive Gynecol 20(3):333 Duepree H, Senagore A, Delaney C, Marcello P, Brady K, Falcone T (2002) Laparoscopic resection of deep pelvic endometriosis with resectosigmoid involvement. J Am Coll Surg 195:754–758 Abrao MS, Goncalves MO, Dias JA, Podgaec S, Garry R, Chamie LP, Blasbailg R (2007) Comparision between clinical examination, transvaginal sonography and magnetic resonance imaging for the diagnosis of deep endometriosis. Hum Reprod 22:3092–3097 Pronio A, Filippo A, Mancini B, Piroli S, Vestri A, Montesani C (2007) Anastomotic dehiscence in colorectalo surgery. Analysis of 1290 ptients. Chir Ital 59:599–609 Guerriero S, Ajoossa S, Gerada M, Virgilio B, Angioni S, Melis GB (2008) Diagnostic value of transvaginal tenderness guided ultrasonography for the prediction of locationdeependometriosis. Human Eprod 23:2452–2457 Goncalves MO, Podgaec S, Dias JA, Gonzaòles M, Abrao MS (2010) Transvaginal ultrasonography with bowel preparation is able to predict the number of lesions and rectosigmoid layers affected in cases of deep endometriosis, defining surgical strategy. Hum Reprod 25:656–671 Sang JL, Ki HP (1999) Ultrasonic energy in endoscopic surgery. Yonsei Med J 40(6):545–549 Philips CK, Hruby GW, Durak E, Lehman DS, Humphrey PA, Mansukhani et al (2008) Tissue response to surgical energy device. Urology 71:744–748 Litta P, Saccardi C, Gizzo S, Conte L, Ambrosi G, Sissi C, Palombo M (2015) Inflammatory cytokine expression following the use of bipolar electrocoagulation, ultracision harmonic scalpel and cold knife biopsy. Mol Med Rep 12(2):2985–2990 Author information Authors and Affiliations Contributions FR: Project development, Data Collection, Methods, Manuscript writing. PD: Methods, Manuscript editing, Data analysis. CV: Manuscript editing. SF: Manuscript editing. GC: Project development, Data Collection, Methods. Corresponding author Ethics declarations Conflict of interest Nothing to disclose about potential conflicts of interest. Informed consent No informed consent needed for this study. Ethical approval This article does not contain any studies with human participants or animals performed by any of the authors (only observational). Rights and permissions About this article Cite this article Rampinelli, F., Donarini, P., Visenzi, C. et al. Surgical laparoscopic treatment of bowel endometriosis with transvaginal resection of the rectum using ultrasonically activated shears: a retrospective cohort study with description of technique. Arch Gynecol Obstet 297, 985–988 (2018). https://doi.org/10.1007/s00404-018-4692-x Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00404-018-4692-x