Sleeve Resection for Rectosigmoid Endometriosis

Study Objective The purpose of this video is to demonstrate the technical bases of a new conservative surgical technique, called Sleeve Resection (SR), for the treatment of endometriosis infiltrating the rectosigmoid wall. Design The SR technique was used as an alternative to the shaving and discoid resection techniques. Setting Lesions infiltrating the muscular layer of the wall of the low, medium, high rectum or sigmoid, separated or contiguous, were excised using a endoscopic linear stapler inserted through intentional colpotomy or using the existing vaginal opening during hysterectomy or endometriosis resection infiltrating the posterior vaginal fornix. Patients or Participants From June 2013 to May 2020, 82 patients, diagnosed preoperative or during surgery, underwent resection of all lesions. Interventions Lesions located in the retosigmoid were identified. Vicryl-00 stitches, transfixed in a long way in the longitudinal direction of the intestinal loop and drawn ventrally, provided an adequate individualization of the lesion margins. The endoscopic linear stapler was inserted parallel to the axis of the rectosigmoid through vaginal route for the excision of one or more lesions. Intestinal permeability was ensured through the placement of a 2.0 cm transanal probe. Additional stapling, sequential or interspersed, were used for total excision of one or multiple lesions. Measurements and Main Results All lesions were fully resected. At postoperative, there was no evidence of leakage or stenosis and neither immediate nor late intestinal obstruction up to a maximum followup of 7 years. Conclusion The laparoscopic sleeve resection technique, using the vaginal route as an access for the endoscopic linear stapler, proved to be safe and feasible for the short and medium followup and can be an alternative to traditional shaving and discoid resection techniques. A significant number of segmental resections were avoided. Future studies are needed to assure the effectiveness of this technique.