Natural Orifice Specimen Extraction Colorectal Resection for Deep Endometriosis: A 50 Case Series

Grigoriadis, Georgios; Dennis, Thomas; Merlot, Benjamin; Forestier, Damien; Noailles, Myriam; François, Marc Olivier; Hajdinák, Adrienn; Roman, Horace

doi:10.1016/j.jmig.2022.05.009

Cited by 12 publications

(4 citation statements)

References 28 publications

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“…The NOSE technique has been applied since 2021 and was used in 13 out of 97 cases in the robotic-assisted approach group as an alternative to conventional minilaparotomy to extract the specimen after the colorectal resection. In our analysis, the NOSE technique was not associated with an increased risk of anastomosis complications (Table S1), which is consistent with previous studies [20,21]. Due to the progressive reduction in the utilization of the preventive stoma in the IFEM Endo since 2018, we were not able to evaluate stoma complications.…”

Section: Discussionsupporting

confidence: 88%

“…Disc excisions were routinely performed using an end-to-end anastomosis circular stapler [16,17]. Colorectal segmental resection was carried out with specimen extraction through a 3-4 cm suprapubic incision or using the natural orifice specimen extraction (NOSE) technique [20,21]. The suture of the vagina was performed using separate Vicryl 0 (Ethicon Inc.) stitches or a running 3-0 V-loc (Medtronic) suture.…”

Section: Interventionsmentioning

confidence: 99%

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Robotic‐assisted versus conventional laparoscopic approach in patients with large rectal endometriotic nodule: the evaluation of safety and complications

Volodarsky‐Perel,

Merlot,

Denost

et al. 2023

Colorectal Disease

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AimThe aim was to compare postoperative complications in patients undergoing the excision of a rectal endometriotic nodule over 3 cm by a robotic‐assisted versus a conventional laparoscopic approach.MethodsWe conducted a retrospective cohort study evaluating prospectively collected data. The main interventions included rectal shaving, disc excision or colorectal resection. All the surgeries were performed in one endometriosis reference institute. To evaluate factors significantly associated with the risk of anastomosis leakage or fistula and bladder atony, we conducted a multivariate logistic regression model.ResultsA total of 548 patients with rectal endometriotic nodule over 3 cm in diameter (#ENZIAN C3) were included in the final analysis. The demography and clinical characteristics of women managed by the robotic‐assisted (n = 97) approach were similar to those of patients who underwent conventional laparoscopy (n = 451). The multivariate logistic regression demonstrated that the surgical approach (robotic‐assisted vs. laparoscopic) was not associated with the rate of anastomosis leakage or fistula (adjusted odds ratio [aOR] 1.2, 95% confidence interval [CI] 0.3–4.0) and bladder dysfunction (aOR 0.5, 95% CI 0.1–1.8). A rectal nodule located lower than 6 cm from the anal verge was significantly associated with anastomosis leakage (aOR 4.1, 95% CI 1.4–10.8) and bladder atony (aOR 4.3, 95% CI 1.5–12.3). Anastomosis leakage was also associated with smoking (aOR 3.2, 95% CI 1.4–7.4), significant vaginal infiltration (aOR 2.7, 95% CI 1.2–6.7) and excision of nodules involving sacral roots (aOR 5.6, 95% CI 1.7–15.5).ConclusionThe robotic‐assisted approach was not associated with increased risk of main postoperative complications compared to conventional laparoscopy for the treatment of large rectal endometriotic nodules.

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Section: Discussionsupporting

confidence: 88%

Section: Interventionsmentioning

confidence: 99%

Robotic‐assisted versus conventional laparoscopic approach in patients with large rectal endometriotic nodule: the evaluation of safety and complications

Volodarsky‐Perel,

Merlot,

Denost

et al. 2023

Colorectal Disease

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“…Compared to the conventional approach, it is associated with improved cosmesis [2], lower risk of incisional hernia [3], shorter recovery [4], less postoperative pain and analgesia requirements [5,6]. It may be associated with greater postoperative inflammatory response [7]; however, potential intraperitoneal bacterial contamination does not appear to translate into increased infective morbidity [8,9].…”

Section: The First Case Report Of Colectomy Done With the Nose Techniquementioning

confidence: 99%

Colectomy for endometriosis with natural orifice specimen extraction technique in 10 steps – a video vignette

Grigoriadis¹,

Merlot²,

Dennis³

et al. 2022

Colorectal Disease

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“…Within the DE spectrum, bowel endometriosis has been estimated to affect between 5% and 12% of patients 3 . The rectum and sigmoid are involved in up to 90% of all intestinal lesions, 4 and a laparoscopic resection of the affected part of the bowel may be required in cases of either occlusive symptoms or patients with nonresponsive medical pain 5–7 . However, surgical management of bowel endometriosis is still controversial, with a broad variety of potential approaches applied, including rectal shaving, disc resection, and segmental resection techniques.…”

Section: Introductionmentioning

confidence: 99%

Vascular‐ and nerve‐sparing bowel resection for deep endometriosis: A retrospective single‐center study

Ianieri,

De Cicco Nardone,

Benvenga

et al. 2023

Intl J Gynecology & Obste

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ObjectiveSurgical management of bowel endometriosis is still controversial. Recently, many authors have pointed out the potential benefits of preserving the superior rectal artery, thus ensuring better perfusion of the anastomosis. The aim of this study was to evaluate the complication rate and functional outcomes of a bowel resection technique for deep endometriosis (DE) involving a nerve‐ and vascular‐sparing approach.MethodsA single‐center retrospective study was conducted by enrolling patients who underwent segmental resection of the rectus sigmoid for DE in our department between September 2019 and April 2022. Intraoperative and postoperative complications were recorded for each woman, and functional outcomes relating to the pelvic organs were assessed using validated questionnaires (Knowles‐Eccersley‐Scott‐Symptom [KESS] questionnaire and Gastro‐Intestinal Quality of Life Index [GIQLI] for bowel function, Bristol Female Lower Urinary Tract Symptoms [BFLUTS] for urinary function, and Female Sexual Function Index [FSFI] for sexual function). These were evaluated preoperatively and postoperatively after 6 months from surgery.ResultsSixty‐one patients were enrolled. No patients had Clavien‐Dindo grade 3 or 4 complications, there were no rectovaginal fistulas or ureteral lesions, and in no cases was it necessary to reoperate. Temporary bladder voiding deficits were reported in 8.2% of patients, which were treated with self‐catheterizations, always resolving within 45 days of surgery. Gastrointestinal function evaluated by KESS and GIQLI improved significantly after surgery, whereas sexual function appeared to worsen, although without reaching the level of statistically significant validity.ConclusionOur vascular‐ and nerve‐sparing segmental bowel resection technique for DE had a low intraoperative and postoperative complication rate and produced an improvement in gastrointestinal function after surgery.

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Natural Orifice Specimen Extraction Colorectal Resection for Deep Endometriosis: A 50 Case Series

Cited by 12 publications

References 28 publications

Robotic‐assisted versus conventional laparoscopic approach in patients with large rectal endometriotic nodule: the evaluation of safety and complications

Robotic‐assisted versus conventional laparoscopic approach in patients with large rectal endometriotic nodule: the evaluation of safety and complications

Colectomy for endometriosis with natural orifice specimen extraction technique in 10 steps – a video vignette

Vascular‐ and nerve‐sparing bowel resection for deep endometriosis: A retrospective single‐center study

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