Precise Resection of Rectal Endometriosis with Intra-Operative Trans-Anal Endoscopy

Abstract

<h3>Study Objective</h3> The challenge of rectal endometriosis surgery is how to achieve the complete resection and preserve the bowel function to the greatest extent. This video demonstrates a laparoscopic surgery assisted by trans-analy hysteroscopy to precisely locate and resect the rectal lesion. <h3>Design</h3> Stepwise demonstration of the surgery. <h3>Setting</h3> In a tertiary university-based hospital. <h3>Patients or Participants</h3> A 34-year-old woman had secondary dysmenorrhea for more than 10 years and anal distension during menstruation for 1 year. Preoperative colonoscopy suggested that there was a 2*3cm hyperemia and edema lesions penetrating mucous membrane in rectal 10cm, which was considered as rectal endometriosis. <h3>Interventions</h3> During laparoscopic surgery, it was not easy to precisely locate the penetrating lesion involving rectum even after shaving the seromuscular lesions. Then we used trans-anal hysteroscopy to perform as colonoscopy to position the penetrating lesion and resect it. There was only a tear of 3cm on the rectum which we anastomosed with a lateral stapler. <h3>Measurements and Main Results</h3> The patient passed gas on Day 2 and restored bowel movement. Her symptom was relieved with satisfying quality of life. <h3>Conclusion</h3> In rectal endometriosis, we can use hysteroscopy as an alternative type of colonoscopy to locate the penetrating lesion accurately, and the precise resection can help retaining the bowel function and preserve the patients' quality of life.