V-NOSE en bloc laparoscopic hysterectomy with segmental bowel resection for deep infiltrating endometriosis (#ENZIAN C3)

BACKGROUND: Deep endometriosis (DE) with intestinal involvement occurs in up to 16% of patients with endometriosis, representing one of the most challenging manifestations of the disease. OBJECTIVES: To describe a laparoscopic technique for the management of DE with bowel involvement through an en bloc resection that includes hysterectomy, appendectomy, and segmental bowel resection, using natural orifice specimen extraction (V-NOSE). PARTICIPANT: A 35-year-old woman presented with severe dysmenorrhea, deep dyspareunia, and intestinal symptoms. A pelvic magnetic resonance imaging revealed a 3.9 cm #ENZIAN C3 intestinal nodule. INTERVENTION: A laparoscopic approach was employed to perform an en bloc resection of the C3 rectal nodule, including segmental bowel resection and end-to-end anastomosis, with the V-NOSE technique. The patient provided informed consent for the publication of this video article and its online posting. The total time for the operation was 100 minutes, and the estimated blood loss was 30 mL. The complete excision was accomplished without intraoperative complications. The postoperative course was uneventful: the patient tolerated oral intake at 48 hours and was discharged 76 hours after surgery. CONCLUSIONS: En bloc laparoscopic hysterectomy enables complete excision of DE with bowel involvement and could reduce operative time and complications, potentially contributing to favourable long-term outcomes. WHAT IS NEW?: The integration of a laparoscopic approach, anterior colpotomy with the uterus attached to the rectovaginal nodule, and V-NOSE specimen extraction could represent a safe and efficient strategy for complex cases of deep infiltrating endometriosis with intestinal involvement in carefully selected patients.