Surgical Endoscopy

, Volume 30, Issue 6, pp 2626–2627 | Cite as

Deep shaving and transanal disc excision in large endometriosis of mid and lower rectum: the Rouen technique

  • Horace RomanEmail author
  • Carole Abo
  • Emmanuel Huet
  • Jean-Jacques Tuech



Colorectal resection is performed in a majority of patients presenting with large endometriosis of mid and lower rectum; however, it may negatively and irreversibly impact postoperative rectal function. To avoid such unfavourable outcomes, we propose an original technique combining laparoscopic deep rectal shaving and transanal disc excision using a semi-circular stapler.


The video presents the procedure performed in a 29-year-old nullipara referred with a large endometriotic nodule infiltrating the lower rectum on more than 30 mm length. The first step is laparoscopic and involves deep rectal shaving performed using exclusively the plasma energy. Then, transanal excision of shaved area is performed, by placing traction parachute sutures in the middle and outside the shaved area. Their traction induces the prolapse of shaved area that is resected using a semicircular stapler. Insufflating the rectum with air checks the integrity of the staple line.


Operative time was 210 min. Immediate postoperative outcomes were uneventful, and bowel movements were normal beginning with day 6. Our technique is suitable in large rectal nodules located up to 10 cm above the anus, infiltrating the rectum on up to 6 cm length, and these parameters are preoperatively assessed using MRI and computed tomography. To date, it was successfully carried out in 29 women with large deep endometriosis of the mid and lower rectum. Rectovaginal fistula was recorded in one patient (3.6 %) and transitory bladder dysfunction in seven patients (25 %). Digestive function assessment using standardized questionnaires revealed an overall improvement, without de novo anal continence troubles. Postoperative pregnancy rate was 78 % with a majority of patients having conceived spontaneously.


Based on our experience, we believe that our conservative technique is feasible and reproducible in large mid and lower rectal endometriosis and might avoid the risk of unfavourable outcomes related to low colorectal resection.


Deep endometriosis Colorectal endometriosis Disc excision Full thickness excision Colorectal resection Transanal stapler 


Compliance with ethical standards


Horace Roman reports personal fees for participating in a symposium and a masterclass presenting his experience in the use of PlasmaJet. Carole Abo has no conflict of interest. Emmanuel Huet has no conflict of interest. Jean-Jacques Tuech has no conflict of interest.

Supplementary material

Supplementary material 1 (MOV 130,774 kb)


  1. 1.
    Roman H, Bridoux V, Tuech JJ, Marpeau L, da Costa C, Savoye G, Puscasiu L (2013) Bowel dysfunction before and after surgery for endometriosis. Am J Obstet Gynecol 209:524–530CrossRefPubMedGoogle Scholar
  2. 2.
    Roman H, Vassilieff M, Bridoux V, Resch B, Marpeau L, Tuech JJ (2013) Postoperative digestive function after radical versus conservative surgical philosophy for deep endometriosis infiltrating the rectum. Fertil Steril 99:1695–1704CrossRefPubMedGoogle Scholar
  3. 3.
    Minelli L, Fanfani F, Fagotti A, Ruffo G, Ceccaroni M, Mereu L, Landi S, Pomini P, Scambia G (2009) Laparoscopic colorectal resection for bowel endometriosis: feasibility, complications, and clinical outcome. Arch Surg 144:234–239CrossRefPubMedGoogle Scholar
  4. 4.
    Daraï E, Dubernard G, Coutant C, Frey C, Rouzier R, Ballester M (2010) Randomized trial of laparoscopically assisted versus open colorectal resection for endometriosis: morbidity, symptoms, quality of life, and fertility. Ann Surg 251:1018–1023CrossRefPubMedGoogle Scholar
  5. 5.
    Bridoux V, Roman H, Kianifard B, Vassilieff M, Marpeau L, Michot F, Tuech JJ (2012) Combined transanal and laparoscopic approach for the treatment of deep endometriosis infiltrating the rectum. Hum Reprod 27:418–426CrossRefPubMedGoogle Scholar
  6. 6.
    Roman H (2013) Deep shaving using PlasmaJet in deep endometriosis of the rectum. Fertil Steril 100:e33CrossRefPubMedGoogle Scholar
  7. 7.
    Slim K (1999) First validation of the French version of the Gastrointestinal Quality of Life Index (GIQLI). Gastroenterol Biol Clin 23:25–31Google Scholar
  8. 8.
    Knowles CH, Scott SM, Legg PE, Allison ME, Lunniss PJ (2002) Level of classification performance of KESS (symptom scoring system for constipation) validated in a prospective series of 105 patients. Dis Colon Rectum 45:842–843CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Horace Roman
    • 1
    • 2
    Email author
  • Carole Abo
    • 1
  • Emmanuel Huet
    • 3
  • Jean-Jacques Tuech
    • 3
    • 4
  1. 1.Department of Gynecology and ObstetricsRouen University HospitalRouenFrance
  2. 2.Research Group EA 4308 ‘Spermatogenesis and Male Gamete Quality’Rouen University HospitalRouenFrance
  3. 3.Department of Digestive SurgeryRouen University HospitalRouenFrance
  4. 4.Digestive Tract Research Group EA3234/IFRMP23Rouen University HospitalRouenFrance

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