Laparoscopic Eradication of Deep Endometriosis With Segmental Rectosigmoid Resection and Bilateral Posterior Parametrectomy With Nerve-sparing “Touchless” Technique According to the “Negrar Method”

Abstract

ObjectiveTo demonstrate nerve-sparing laparoscopic eradication of Deep Endometriosis with rectal and parametrial resection based on the Negrar Method1 utilizing the “Touchless” Technique. Designstepwise video case demonstration with narration SettingTertiary Level Endometriosis Unit. The patient was a 28 year-old nulliparous patient referred for surgery with persistent dysmenorrhea, dyspareunia and dyschezia despite medical management (progestin containing hormonal pills). Preoperative ultrasound demonstrated bilateral endometriomas, diffuse adenomyosis and 35mm x 17mm stenosing rectal nodule. Histopathology confirmed 60% stenosis of the rectum secondary to the endometriotic nodule up to submucosal layer with margins free of endometriosis. She was discharged 7 days post-operatively with no post operative complications. InterventionsLaparoscopic nerve sparing eradication of Deep Endometriosis with Segmental Rectosigmoid Resection and bilateral posterior parametrectomy according to the “Negrar Method” with Nerve-Sparing "Touchless" Technique, sliding the nerve-bundles latero-caudally, keeping intact the visceral pelvic fascia covering them, thus without direct contact with the nerves. ConclusionIn our experience, based on more than 3000 of these procedures 3, this nerve-sparing procedure, based on identifying the nerves and their latero-caudad dissection, without a direct impact on their fibers but just on their fascial envelopes has proven successful in lowering the rates of post-operative dysfunctions and neural impairment related to neuro-apraxia and edema which occurs by directly impacting them.1 Whilst there is no robust data to demonstrate benefit of “touchless” nerve sparing dissection techniques, neuro-apraxia from compression of neural fibers which has been observed can be minimized.1,4,5