Nastasia Şerban, Simionescu Anca Angela, Tuech Jean Jacques, Roman Horace
Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, Carol Davila University of Medicine and Pharmacy, 11-13 Ion Mihalache Blv, District 1, 011171 Bucharest, Romania.
J Pers Med. 2021 May 13;11(5):408. doi: 10.3390/jpm11050408.
The complete excision of low rectovaginal deep endometriosis is a demanding surgery associated with an increased risk of intra- and postoperative complications, which can impact the quality of life. Given the choices of optimal surgery procedures available, we would like to emphasize that a minimally invasive approach with plasma medicine and a transanal disc excision could significantly improve surgery for deep endometriosis, avoiding the lateral thermal damage of vascular and parasympathetic fibers of roots S2-S5 in the pelvic plexus. The management of low rectal deep endometriosis is distinct from other gastrointestinal-tract endometriosis nodules. Suggestions and explanations are presented for this minimal approach. These contribute to individualized medical care for deep endometriosis. In brief, a laparoscopic transanal disc excision (LTADE; Rouen technique) was performed through a laparoscopic deep rectal dissection, combined with plasma energy shaving, and followed by a transanal disc excision of the low and mid-rectal deep endometriotic nodules, with the use of a semi-circular stapler. LTADE is indicated as the first-line surgical treatment for low and mid-rectal deep endometriotic nodule excisions, because it can preserve rectal length and innervation. This technique requires a multidisciplinary team with surgical colorectal training.
低位直肠阴道深部子宫内膜异位症的完整切除是一项具有挑战性的手术，术中及术后并发症风险增加，这可能会影响生活质量。鉴于现有的最佳手术方法选择，我们想强调的是，采用等离子医学和经肛门盘状切除术的微创方法可显著改善深部子宫内膜异位症的手术效果，避免盆腔丛中S2 - S5神经根的血管和副交感神经纤维受到侧向热损伤。低位直肠深部子宫内膜异位症的处理与其他胃肠道子宫内膜异位症结节不同。本文针对这种微创方法提出了建议和解释。这些有助于为深部子宫内膜异位症提供个体化医疗。简而言之，通过腹腔镜直肠深部解剖，结合等离子能量刮除术，然后使用半圆形吻合器经肛门切除低位和中位直肠深部子宫内膜异位结节，实施腹腔镜经肛门盘状切除术（LTADE；鲁昂技术）。LTADE被指定为低位和中位直肠深部子宫内膜异位结节切除的一线手术治疗方法，因为它可以保留直肠长度和神经支配。该技术需要一个经过结直肠手术培训的多学科团队。
