Sydney Women's Endosurgery Centre (Drs. Chou, Cario, Rosen, Choi, Al-Shamari, and Bukhari), Sydney, Australia.
Sydney Colorectal Associates (Dr. Perera), Sydney, Australia.
J Minim Invasive Gynecol. 2020 Feb;27(2):268-269. doi: 10.1016/j.jmig.2019.11.012. Epub 2019 Nov 26.
To demonstrate laparoscopic shaving of deeply infiltrative endometriosis affecting the rectosigmoid colon, with particular emphasis on the anatomic and technical aspects of the procedure.
Stepwise demonstration of the technique with narrated video footage.
Intestinal involvement in deep endometriosis is estimated to occur in 8% to 12% of patients, with 90% of occurrences being located in the colorectal segment. Deep endometriosis of the rectosigmoid is defined as endometriosis involving the muscular layer of the bowel wall, usually >5 mm deep, thus excluding superficial lesions that only affect the serosal layer. In cases in which medical therapy is unsatisfactory, rectosigmoid deep endometriosis can be surgically managed by 3 recognized surgical techniques: (1) rectal shaving, (2) disc excision, and (3) segmental resection. There are helpful recommendations for different approaches on the basis of the characteristics of the lesion, including the size, length, depth of invasion, involved rectal circumference, and number of lesions, among other factors [1]. Rectal shaving is well suited for smaller lesions, typically <3 cm, and involves "shaving" the lesion in the affected muscular layer of the bowel wall off the mucosa, ideally without entering the bowel lumen. It is associated with lower rates of perioperative complications and lower probability of long-term postoperative bladder and bowel dysfunctions [2].
This video demonstrates and highlights the anatomic and technical aspects of the following important steps of the rectal shaving procedure: (1) suspension of ovaries; (2) mobilization of the diseased segment of the rectum; (3) shaving of the lesions, with pertinent comments at different stages of nodule excision; (4) checking for the integrity of the bowel wall; and (5) suture of the muscularis defect after excision of the lesions from the muscularis layer of the bowel.
Compared with other alternatives, shaving for bowel endometriosis is a more conservative procedure with lower rates of perioperative complications, and it is less likely to result in long-term bladder and bowel dysfunctions. Therefore, shaving is preferable and recommended for appropriate lesions.
展示影响直肠乙状结肠的深部浸润性子宫内膜异位症的腹腔镜刮除术，特别强调该手术的解剖和技术方面。
分步演示技术，并配有解说视频。
深部子宫内膜异位症累及肠道的估计发生率为 8%至 12%，其中 90%的发生部位位于结直肠段。直肠乙状结肠深部子宫内膜异位症定义为累及肠壁肌层的子宫内膜异位症，通常 >5mm 深，因此不包括仅影响浆膜层的表浅病变。对于药物治疗不满意的病例，直肠乙状结肠深部子宫内膜异位症可以通过 3 种公认的手术技术进行手术治疗：（1）直肠刮除术，（2）盘状切除术，和（3）节段切除术。根据病变的特征，包括病变的大小、长度、深度、受累直肠周径和病变数量等因素，对不同方法有有益的建议[1]。直肠刮除术适用于较小的病变，通常 <3cm，涉及“刮除”受累肠壁肌层中的病变，脱离黏膜，理想情况下不进入肠腔。它与较低的围手术期并发症发生率和较低的长期术后膀胱和肠道功能障碍的概率相关[2]。
本视频演示并强调了直肠刮除术的以下重要步骤的解剖和技术方面：（1）卵巢悬吊；（2）病变直肠段的游离；（3）病变刮除，在结节切除的不同阶段有相关评论；（4）检查肠壁的完整性；和（5）切除病变后缝合肠壁肌层的肌层缺陷。
与其他替代方法相比，肠子宫内膜异位症的刮除术是一种更保守的手术，围手术期并发症发生率较低，且不太可能导致长期膀胱和肠道功能障碍。因此，对于适当的病变，刮除术是优选和推荐的。
