Laparoscopic discoid resection in rectal endometriosis: When less is more

Area of Science:

• Minimally Invasive Surgery
• Gynecologic Surgery
• Colorectal Surgery

Background:

• Laparoscopic discoid resection is a conservative alternative to segmental resection for rectal deep infiltrating endometriosis (DIE).
• This technique excises infiltrative lesions while preserving rectal continuity and minimizing morbidity.
• Widespread adoption is limited by technical challenges.

Purpose of the Study:

• To describe a refined approach to laparoscopic discoid resection for rectal DIE.
• To standardize key operative steps for improved safety and reproducibility.
• To broaden the applicability of this conservative surgical technique.

Main Methods:

• Retrospective analysis of 25 patients undergoing laparoscopic discoid resection.
• Systematic rectal mobilization, meticulous shaving, and intraoperative reassessment.
• Use of a rectal dilator and precise circular stapler introduction.

Main Results:

• Refined steps enhance exposure and facilitate stapler positioning.
• Intraoperative reassessment allowed more precise evaluation and strategy conversion.
• Shaving reduced lesion volume; rectal dilator ensured luminal feasibility.

Conclusions:

• Standardized laparoscopic discoid resection is a fertility-preserving, organ-sparing solution for selected rectal DIE patients.
• Technical refinements improve safety, reproducibility, and applicability.
• This approach may reduce the need for aggressive surgery in young women.