Nerve-Sparing Laparoscopic Segmental Bowel Resection for Deep Endometriosis: The Negrar Method

Abstract

<h3>Study Objective</h3> to demonstrate a nerve-sparing technique during laparoscopic segmental bowel resection for deep endometriosis. <h3>Design</h3> A step-by-step demonstration of surgical procedure of laparoscopic segmental bowel resection. <h3>Setting</h3> In several cases, segmental bowel resection may be necessary to achieve complete removal of the disease and significantly improve the quality of life. Laparoscopic complete excision of deep-infiltrating endometriosis can seriously affect bladder, rectal, and sexual function. The goal of the nerve-sparing approach is to better identify the visceral neural fibers and surgical landmarks. <h3>Patients or Participants</h3> patients who underwent nerve-sparing laparoscopic complete excision of endometriosis with segmental bowel resection (‘‘The Negrar Method''). <h3>Interventions</h3> Our surgical nerve-sparing bowel resection technique proceeds in 5 steps: Step 1 Development of the medial pararectal space (Okabayashi's space) and development of the lateral pararectal space (Latzko's space) and isolation of the ureteral course Step 2 Opening of the presacral space, development of avascular spaces, and identification and preservation of pelvic sympathetic fibers of the inferior mesenteric plexus, superior hypogastric plexus, upper hypogastric nerves. Step 3 Development of the rectovaginal space Step 4 The previously skeletonized inferior mesenteric vessels are transected Step 5 Rectal resection and colorectal anastomosis <h3>Measurements and Main Results</h3> The Nerve-sparing technique appears to be feasible and offers good results in terms of reduced bladder morbidity and apparently higher satisfaction than the classical technique. <h3>Conclusion</h3> This kind of surgery requires uncommon surgical skills and anatomical knowledge; we believe that it should be performed only in selected reference centers.