Laparoscopic sigmoidectomy for endometriosis with transanal specimen extraction

STUDY OBJECTIVE: To describe a more conservative and less invasive surgical approach to laparoscopic colorectal segmental resection for treatment of endometriosis. DESIGN: Video of elective sigmoidectomy to treat colorectal endometriosis. SETTING: Tertiary referral center for laparoscopic gynecologic surgery at the University Hospitals of Strasbourg, France. PATIENT: A 29-year-old woman with dysmenorrhea, constipation, and cyclic diarrhea and two sigmoid endometriotic lesions evident at colonoscopy. INTERVENTION: The conservative surgical strategy, possible in cases of benign lesions such as endometriosis, consists of dividing the mesentery close to the digestive tract to preserve the vascular-lymphatic vessels and the surrounding sympathetic and parasympathetic nerves. The less invasive approach consists of natural orifice specimen extraction via the transanal route. MEASUREMENTS AND MAIN RESULTS: The postoperative course was favorable. The conservative technique enables preservation of the superior rectal vessels, which contribute to 80% of the vascularization of the rectum, to maintain the best vascularization, essential for intestinal anastomosis. Transanal specimen extraction maximizes the benefits of laparoscopy by sparing the abdominal wall from incision and its associated complications. CONCLUSION: A conservative surgical approach should be used in segmental bowel resection for treatment of endometriosis. Moreover, the segmental bowel resection can be safely performed with transanal specimen extraction, with great advantages for the patient.