Laparoscopic mesentery-sparing NOSE bowel resection for endometriosis: when and how?

To describe the peri-operative considerations and surgical steps for a laparoscopic segmental resection for colorectal endometriosis, using a nerve-sparing, mesentery-sparing, and natural orifice specimen extraction (NOSE) technique.

Narrated surgical video within a tertiary care hospital. Institutional review board approval was not necessary for this article in accordance with the Tri-Council Policy Statement of Canada, article 2.5.

Recorded case of a 5-cm deep rectal nodule requiring resection.

Laparoscopic segmental resection.

Overview of bowel endometriosis, surgical approaches, peri-operative care, and surgical steps.

The surgical approach is illustrated in 8 steps: mobilization of the adnexa and cul-de-sac, bilateral ureterolysis, dissection of the pararectal and rectovaginal spaces, mesenteric dissection ± sigmoid mobilization, enterotomies and anvil placement, segmental resection and natural orifice specimen extraction, reanastomosis, and rigid sigmoidoscopy. Peri-operative care should align with the Enhanced Recovery After Surgery pathway for colorectal surgery.

In cases of multiorgan endometriosis, gynecologic surgeons must remain at the forefront of clinical decision making and surgical care coordination. The standardization of the surgical approach allows for a safe and reproducible performance of the intervention.