title: Laparoscopic and transanal excision of large lower- and mid-rectal deep endometriotic nodules: the Rouen technique.
abstract: OBJECTIVE
  To report an original technique of combined laparoscopic and transanal disc excision of lower- and mid-rectal deep endometriotic nodules.
  
  
  METHODS
  Video article introducing a new surgical technique.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  A 30-year-old nullipara with symptomatic deep endometriosis-large nodules involving the vagina and the lower rectum over 30 mm.
  
  
  METHODS
  An original technique of combined laparoscopic and transanal approaches, including deep rectal shaving using PlasmaJet, followed by transanal full thickness disc excision of the shaved area using the Contour Transtar stapler.
  
  
  METHODS
  The procedure is based on specific properties of PlasmaJet (the lack of lateral thermal spread making the dissection on contact of the rectal wall safe, the precise ablative property allowing for in situ ablation of rectal endometriosis implants) and those of the Contour Transtar stapler, which was originally developed to perform stapled transanal rectal resection of the internal rectal prolapse or rectocele. The steps of the Rouen technique and the role of the two devices are emphasized. Surgical technique reports in anonymous patients are exempted from ethical approval by the Institutional Review Board. The patient gave consent to use the video in the article.
  
  
  RESULTS
  The patient's functional outcome was uneventful, except for transitory incomplete bladder voiding. Since June 2009, we have successfully employed this technique in 15 patients with low rectal nodules, with only favorable digestive functional outcomes.
  
  
  CONCLUSIONS
  Our technique is suitable for large nodules involving the lower and mid-rectum and avoids low colorectal resection, thus increasing the chance of favorable functional digestive outcomes.
authors.affiliation: Department of Gynecology and Obstetrics and Department of Surgery, Rouen University Hospital, Rouen, France. Electronic address: horace.roman@gmail.com.
authors.forename: Horace
authors.initials: H
authors.lastname: Roman
authors.affiliation: Department of Gynecology and Obstetrics and Department of Surgery, Rouen University Hospital, Rouen, France.
authors.forename: Jean Jacques
authors.initials: JJ
authors.lastname: Tuech
mesh_terms: D000328:Adult; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation; D004715:Endometriosis / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation; D012002:Rectal Diseases / Q000175:diagnosis / Q000601:surgery*; D013528:Surgical Staplers; D017792:Surgical Stapling / Q000295:instrumentation; D016896:Treatment Outcome; D014623:Vaginal Diseases / Q000175:diagnosis / Q000601:surgery*
keywords: Contour Transtar stapler; Deep endometriosis; PlasmaJet; disc excision; full thickness excision; rectal endometriosis; rectal shaving