Deep Rectal Shaving Followed by Transanal Disc Excision in Large Deep Endometriosis of the Lower...
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Accepted Manuscript Deep rectal shaving followed by transanal disc excision in large deep endometriosis of lower rectum Horace Roman, MD PhD Jean-Jacques Tuech, MD PhD Kirana Arambage, MD PII: S1553-4650(14)00197-6 DOI: 10.1016/j.jmig.2014.03.003 Reference: JMIG 2268 To appear in: The Journal of Minimally Invasive Gynecology Received Date: 11 February 2014 Accepted Date: 4 March 2014 Please cite this article as: Roman H, Tuech JJ, Arambage K, Deep rectal shaving followed by transanal disc excision in large deep endometriosis of lower rectum, The Journal of Minimally Invasive Gynecology (2014), doi: 10.1016/j.jmig.2014.03.003. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Transcript of Deep Rectal Shaving Followed by Transanal Disc Excision in Large Deep Endometriosis of the Lower...
Accepted Manuscript
Deep rectal shaving followed by transanal disc excision in large deep endometriosisof lower rectum
Horace Roman, MD PhD Jean-Jacques Tuech, MD PhD Kirana Arambage, MD
PII: S1553-4650(14)00197-6
DOI: 10.1016/j.jmig.2014.03.003
Reference: JMIG 2268
To appear in: The Journal of Minimally Invasive Gynecology
Received Date: 11 February 2014
Accepted Date: 4 March 2014
Please cite this article as: Roman H, Tuech JJ, Arambage K, Deep rectal shaving followed by transanaldisc excision in large deep endometriosis of lower rectum, The Journal of Minimally Invasive Gynecology(2014), doi: 10.1016/j.jmig.2014.03.003.
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service toour customers we are providing this early version of the manuscript. The manuscript will undergocopyediting, typesetting, and review of the resulting proof before it is published in its final form. Pleasenote that during the production process errors may be discovered which could affect the content, and alllegal disclaimers that apply to the journal pertain.
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Original video article 2
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Deep rectal shaving followed by transanal disc excision in large deep endometriosis of 4
lower rectum 5
Horace Roman, MD PhD, Jean-Jacques Tuech, MD PhD, Kirana Arambage, MD 6
Department of Gynecology and Obstetrics, Rouen University Hospital, France 7
Department of Surgery, Rouen University Hospital, France 8
Department of Gynecology and Obstetrics, John Radcliffe Hospital, Oxford, United Kingdom 9
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Correspondence and reprint request: Horace Roman, MD PhD, Clinique Gynécologique et 13
Obstétricale, CHU « Charles Nicolle », 1 rue de Germont, 76031 Rouen, France, Tél : +33 14
2 328 887 54 ; Fax : +33 2 359 811 49 ; Email : [email protected] 15
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Conflict of interest: Prof. Roman reports personal fees from Plasma Surgical Inc. (Roswell, 17
GA, US) for participating in a symposium and a masterclass, where he presented his 18
experience in the use of PlasmaJet®. This was outside the submitted work. 19
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Précis 26
To minimize the risk of unfavorable outcomes related to low colorectal resection for 27
deep endometriosis, we propose an original technique combining the deep rectal shaving and 28
the transanal disc excision. 29
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Abstract 51
Study objective: To report an original technique of deep rectal shaving using 52
PlasmaJet® followed by transanal disc excision using Contour Transtar® stapler suitable in 53
large deep endometriosis of lower rectum. 54
Design: Video article. 55
Setting: Rouen University Hospital. The procedure was performed in a 30 year-old 56
nullipara referred with a large endometriotic nodule infiltrating the right uterosacral ligament 57
and the anterolateral wall of the lower rectum. Rectal infiltration measured 30 mm in diameter 58
and was responsible for stenosis. The first step of the procedure is represented by a 59
laparoscopic deep rectal shaving performed using exclusively the plasma energy, combining 60
the detachement of the nodule from the rectum with in situ ablation of residual endometriotic 61
foci of the shaved area. Then, transanal excision is performed by the colorectal surgeon from 62
rectal approach. Three of four traction parachute sutures are placed in the middle and outside 63
the shaved area. Their traction induces the prolaps of shaved rectal wall, that is resected using 64
the Contour Transtar® stapler, which is a device originally destined to remove rectal prolaps. 65
The final staple line is inspected for bleeding and secured with interrupted resorbable suture 66
as required. Surgical technique reports in anonymous patients are exempted from ethical 67
approval by the IRB. 68
Intervention: Deep rectal shaving using PlasmaJet® followed by transanal disc 69
excision using Contour Transtar® stapler. 70
Results: Immediate postoperative outcomes were uneventful, and bowel movements 71
were normal beginning with day 5. To date, this procedure was successfully carried out in 17 72
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women with large deep endometriosis of the mid and lower rectum, with only favorable rectal 73
functional outcomes. 74
Conclusions: Based on our experience, we believe that our conservative technique is 75
feasible in large low rectal endometriosis and avoids the risk of unfavorable outcomes related 76
to low colorectal resection. 77
Key words: deep endometriosis; rectal endometriosis; rectal shaving; disc excision; 78
plasma energy. 79
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References 100
1. Roman H. Rectal shaving using PlasmaJet in deep endometriosis of the rectum. 101
Fertil Steril 2013; 100: e33. 102
2. Bridoux V, Roman H, Kianifard B, Vassilieff M, Marpeau L, Michot F, Tuech JJ. 103
Combined transanal and laparoscopic approach for the treatment of deep endometriosis 104
infiltrating the rectum. Hum Reprod 2012; 27: 418-26. 105
3. Roman H, Tuech JJ. New disc excision procedure for low and mid rectal 106
endometriosis nodules using combined transanal and laparoscopic approach. Colorectal 107
Diseases 2014 ; In press. 108
4. Roman H, Vassilieff M, Tuech JJ, Huet E, Savoye G, Marpeau L, Puscasiu L. 109
Postoperative digestive function after radical versus conservative surgical philosophy for deep 110
endometriosis infiltrating the rectum. Fertil Steril 2013; 99: 1695-704. 111
5. Nezhat C, Nezhat F, Ambroze W, Pennington E. Laparoscopic repair of small 112
bowel and colon. A report of 26 cases. Surg Endosc 1993 ; 7 : 88-9. 113
6. Nezhat C, Nezhat F, Pennington E, et al. Laparoscopic disk excision and 114 primary repair of the anterior rectal wall for the treatment of full-thickness bowel 115 endometriosis. Surg Endosc 1994;8(6):682-5. 116
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