Design: Case report
Setting: Large academic center
Patients or Participants: 30yo G0 with history of pelvic pain and infertility in the setting of fibroids, left hydrosalpinx diagnosed on HSG and stage IV endometriosis with an obliterated posterior cul-de-sac noted on a previous diagnostic laparoscopy. She was counseled for a complete surgical resection, bilateral salpingectomy and myomectomy.
Interventions: The patient underwent a robotic-assisted laparoscopic myomectomy, extensive endometriosis excision, bilateral salpingectomy, discoid resection of bowel deep infiltrative endometriosis and sigmoidoscopy.
Key surgical steps are illustrated including:
1. Development of the retrorectal space
2. Dissection of the endometriosis nodule off the posterior uterus and vagina
3. Entry into the rectovaginal space
4. Circumferential excision of nodule off the anterior rectum
5. Placement of Alexis retractor into the anus
6. Specimen extraction through open rectal lumen
7. Full thickness rectal lumen closure in multiple layers
Measurements and Main Results: Patient discharged home on POD2 and had an uncomplicated postoperative course. At her 8 weeks postoperative visit, she was recovering well with complete resolution of pelvic pain symptoms and normal bowel function.
Conclusion: Transanal specimen extraction is feasible and effective during rectosigmoid deep nodule excision
Dawodu, O*1, Seaman, SJ1, Gedeon, M2, Arora, C3. 1OBGYN, Columbia Irving Medical Center - New York Presbyterian Hospital, New York, NY; 2Surgery, Columbia Irving Medical Center - New York Presbyterian Hospital, New York, NY; 3Department of Obstetrics and Gynecology, Columbia Irving Medical Center - New York Presbyterian Hospital, New York, NY