Technique for Rectosigmoid Resection with Total Intracorporeal Anastamosis in Colorectal Endometriosis

Abstract

Video Objective To demonstrate step by step technique for laparoscopic rectosigmoid colectomy with total intracorporeal anastomosis in stage IV endometriosis, eliminating the need for laparotomy to complete the procedure. Setting A subspecialist gynecologic surgery practice focused on complex endometriosis care, with collaboration from subspecialist surgery colleagues. Interventions Stage IV endometriosis with colorectal involvement is frequently managed in subspecialty endometriosis practices. In most cases, segmental resection and anastomosis requires a small laparotomy or port extension for installation of the stapler anvil. In recent years, general surgeons managing colon cancer or other general surgical disease states have demonstrated techniques for total intracorporeal laparoscopic colectomy without the need for minilaparotomy, often using the anus as an access point for stapler/anvil installation and specimen extraction. We demonstrate two cases using similar techniques in stage IV endometriosis, using a hysterectomy associated colpotomy as an access point, eliminating the need for laparotomy to complete colorectal anastomosis. Similar techniques can be accomplished via vaginotomy or transanally in cases that do not involve hysterectomy. We describe a repeatable 12 step process for consistent performance of this procedure. Conclusion Total intracorporeal colorectal resection and anastomoses are feasible and reproducible in stage IV endometriosis cases, using the vagina as an access point. In our experience, elimination of minilaparotomy for anastomosis completion promotes early discharge from hospital, surgical recovery, and patient satisfaction.