Laparoscopic Reverse Technique for Posterior Rectovaginal Deep Endometriosis Nodule Step by Step

Area of Science:

• Minimally Invasive Surgery
• Gynecologic Oncology
• Endometriosis Research

Background:

• Deep infiltrating endometriosis (DIE) poses surgical challenges, particularly when involving the rectovaginal septum and anterior rectal wall.
• Traditional surgical approaches may offer limited visualization and maneuverability for complex DIE cases.
• Standardization of surgical techniques is crucial for improving patient outcomes and facilitating training.

Observation:

• A case report details the laparoscopic application of the reverse technique for a 32-year-old woman with symptomatic DIE.
• The technique involves dissecting the endometriotic nodule from the rectal wall as a final step, preserving rectal integrity.
• Key steps include pelvic inspection, ovarian lesion removal, ureteral identification, dissection of pararectal fossae, posterior vaginal fornix resection, and rectal shaving.

Findings:

• The reverse technique allows for enhanced rectal wall mobilization, facilitating precise dissection of the endometriotic nodule.
• This approach provides ergonomic advantages and allows the surgeon to select the optimal method for rectal disease treatment (shaving or resection).
• The described procedure was completed successfully, with the anterior rectal wall closure and posterior vaginal fornix reattachment performed meticulously.

Implications:

• The laparoscopic reverse technique presents a viable alternative for managing retrocervical and rectovaginal DIE nodules.
• This standardized 10-step procedure can improve surgical safety, comprehension, and reproducibility.
• Further studies are warranted to evaluate the long-term efficacy and broader applicability of this innovative surgical approach.