Stapled disc excision for the repair of intraoperative rectal injury during robotic surgery for deep infiltrating endometriosis

Introduction Intraoperative rectal perforation is an uncommon complication of pelvic surgery, which can be life-threatening and often leads to high morbidity and stoma formation rate. Purpose No consensus has been reached regarding a standard of care for intraoperative iatrogenic pelvic injury. This article presents a technique for a stapled repair to completely resect a full-thickness low rectal perforation during robotic surgery for advanced endometriosis and avoid a high-risk colorectal anastomosis and the possible need for stoma formation.

Stapled discoid excision is a novel and safe technique for the repair of intraoperative rectal injuries, showing multiple benefits compared to the standard colorectal resection with or without anastomosis.

van der Voort M, Heijnsdijk EA, Gouma DJ (2004) Bowel injury as a complication of laparoscopy. Br J Surg 91(10):1253–1258. https://doi.org/10.1002/bjs.4716 Levine JH, Longo WE, Pruitt C, Mazuski JE, Shapiro MJ, Durham RM (1996) Management of selected rectal injuries by primary repair. Am J Surg 172(5):575. https://doi.org/10.1016/S0002-9610(96)00244-9 Nezhat C, Nezhat F, Pennington E, Nezhat CH, Ambroze W (1994) Laparoscopic disk excision and primary repair of the anterior rectal wall for the treatment of full-thickness bowel endometriosis. Surg Endosc 8(6):682–685. https://doi.org/10.1007/BF00678566 Gordon SJ, Maher PJ, Woods R (2001) Use of the CEEA stapler to avoid ultra-low segmental resection of a full-thickness rectal endometriotic nodule. J Am Assoc Gynecol Laparosc 8(2):312–316. https://doi.org/10.1016/s1074-3804(05)60598-1 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(6):524-530. https://doi.org/10.1016/j.ajog.2013.04.015 Llarena NC, Shah AB, Milad MP (2015) Bowel injury in gynecologic laparoscopy: a systematic review. Obstet Gynecol 125(6):1407–1417. https://doi.org/10.1097/AOG.0000000000000855 Rocco B, Giorgia G, Simone A, Tommaso C, Mattia S, Stefano T, Ahmed E, Giorgio B, De Concilio B, Celia A, Salvatore M, Sighinolfi MC (2022) Rectal perforation during pelvic surgery. Eur Urol Open Sci 28(44):54–59. https://doi.org/10.1016/j.euros.2022.04.006 Leevan E, Carmichael JC (2019) Iatrogenic bowel injury. Semin Colon Rectal Surg 30:100688. https://doi.org/10.1016/J.SCRS.2019.100688 Karadag MA, Cecen K, Demir A, Bagcioglu M, Kocaaslan R, Kadioglu TC (2015) Gastrointestinal complications of laparoscopic/robot-assisted urologic surgery and a review of the literature. J Clin Med Res 7(4):203. https://doi.org/10.14740/jocmr2090w Ethics declarations Patient consent Consent from the patient was obtained for photographic and video material to be used in educational publications intended for health professionals. Conflicts of interest The authors declare no competing interests. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary information ESM 1 Rights and permissions About this article Cite this article Manzo, C.A., Celentano, V. Stapled disc excision for the repair of intraoperative rectal injury during robotic surgery for deep infiltrating endometriosis. Langenbecks Arch Surg 408, 153 (2023). https://doi.org/10.1007/s00423-023-02890-9 Received: Accepted: Published: Version of record: DOI: https://doi.org/10.1007/s00423-023-02890-9