Robotic assisted rectal disk excision: the 3-cm diameter cut off may be abandoned

Area of Science:

• Minimally Invasive Surgery
• Gynecologic Surgery
• Colorectal Surgery

Background:

• Rectovaginal endometriosis can infiltrate the rectum, necessitating surgical intervention.
• Traditional excision methods may pose challenges for deep or large nodules.

Purpose of the Study:

• To describe a standardized technique for robotic-assisted transanal full-thickness rectal excision of rectovaginal endometriosis nodules.
• To evaluate the feasibility of this combined approach.

Main Methods:

• A combined robotic and transanal approach was used for full-thickness disk excision of large rectovaginal endometriosis nodules.
• Robotic scissors facilitated precise rectal shaving, followed by stapler closure using a 33 mm circular transanal stapler.

Main Results:

• The technique is designed for deep nodules infiltrating 3-5 cm of the middle and low rectum.
• Robotic assistance was found to improve the feasibility of rectal shaving for large nodules causing intrarectal protrusion.

Conclusions:

• Robotic-assisted transanal rectal excision is a feasible technique for managing extensive rectovaginal endometriosis.
• Precise rectal shaving, aided by robotic technology, is crucial for successful stapler excision.