Design: A stepwise demonstration of laparoscopic rectal shaving and closure of bowel serosal defect.

Setting: A tertiary academic hospital with Minimally Invasive Gynecologic Surgery and Colorectal specialists

Patients or Participants: A 30-year-old who presented with chronic pelvic pain and history of endometriosis. Preoperative ultrasound showed an immobile uterus with a suspected bowel nodule.

Interventions: DIE is defined by subperitoneal invasion of endometriosis lesions by greater than 5mm. Bowel endometriosis is reported in 3.8-37% of patients with endometriosis and can be less responsive to medical therapy alone. Surgical management of bowel endometriosis depends on the size of the lesion and includes bowel shaving, discoid resection, or bowel resection. After our patient underwent consultation with appropriate imaging and counseling, she was consented for surgical intervention with bowel shaving and possible bowel resection.

Measurements and Main Results: The patient had a diagnostic laparoscopy, resection of endometriosis, bilateral ureterolysis, significant adhesiolysis and enterolysis, and rectal shaving for advanced-stage endometriosis. A serosal bowel shaving for a <3 cm endometriosis lesion was performed without any defects to the muscularis layer. The bowel serosa was laparoscopically repaired with 3-0 Vicryl suture in a continuous fashion. The final pathology was consistent with endometriosis.

Conclusion: Rectal shaving is a safe and conservative approach for most bowel endometriosis lesions and has the fewest complications. The recurrence rate of endometriosis is similar between rectal shaving and resection. Rectal shaving should be performed by a trained specialist and a laparoscopic bowel repair can be performed in a safe manner.