Kathopoulis Nikolaos, Vlachos Dimitrios-Efthimios, Kypriotis Konstantinos, Diakosavvas Michail, Chatzipapas Ioannis, Protopapas Athanasios
1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (all authors).
1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (all authors).
J Minim Invasive Gynecol. 2023 Jan;30(1):11-12. doi: 10.1016/j.jmig.2022.11.007. Epub 2022 Nov 18.
To demonstrate the technique of discoid excision of bowel endometriosis followed by closure of the bowel defect using sutures, without the application of the transanal stapler device.
Stepwise demonstration of the technique with narrated video footage.
Bowel endometriosis is a common pattern of deep endometriosis [1]. Discoid excision is 1 of the 3 surgical interventions applied to manage this pathologic entity, with shaving and segmental resection being the other 2 [2]. When discoid excision is performed, a transanal stapler device is used for bowel closure in most cases [3,4]. Only a few studies so far have reported the application of sutures for this purpose [5]. This video highlights the technique of bowel suturing after discoid excision.
This video presents the technique of bowel discoid excision with the application of sutures to close the bowel defect (Supplemental Video 1). The key surgical steps are as follows: 1. Dissection of both ureters and development of pararectal spaces. 2. Recognition and preservation of the inferior hypogastric plexus and the hypogastric nerve. 3. Detachment of the nodule from the cervix. 4. Detachment of the nodule from the bowel, beginning with deep shaving and followed by discoid excision. 5. Thorough description of the bowel closure using 2 layers of Vicryl 3-0 sutures, the first being interrupted and the second continuous.
The described technique of bowel closure using sutures may be a safe and effective alternative to the transanal stapler. Its advantage is that it can be performed when the pathology is located higher than 15 cm from the anal verge or the diameter of the nodule is more than 30 mm.
展示肠内异症盘状切除术的技术，随后使用缝线关闭肠缺损，而不应用经肛门吻合器装置。
通过旁白视频片段逐步展示该技术。
肠内异症是深部内异症的常见类型[1]。盘状切除术是用于处理该病理实体的三种手术干预措施之一，另外两种是削除术和节段切除术[2]。在进行盘状切除术时，大多数情况下使用经肛门吻合器装置进行肠闭合[3,4]。到目前为止，只有少数研究报道为此目的应用缝线[5]。本视频重点介绍盘状切除术后肠缝合技术。
本视频展示了应用缝线关闭肠缺损的肠盘状切除技术（补充视频1）。关键手术步骤如下：1. 游离双侧输尿管并打开直肠旁间隙。2. 识别并保留下腹下丛和腹下神经。3. 将结节从宫颈分离。4. 将结节从肠管分离，先进行深部削除，然后进行盘状切除。5. 详细描述使用两层3-0薇乔缝线进行肠闭合，第一层为间断缝合，第二层为连续缝合。
所描述的使用缝线进行肠闭合的技术可能是经肛门吻合器的一种安全有效的替代方法。其优点是当病变位于距肛缘15 cm以上或结节直径大于30 mm时可以实施。
