Design: Video presentation of surgical technique.

Setting: This surgery was performed in a community hospital. The patient was placed in Trendelenburg, dorsal lithotomy position and the robot was docked from the patient’s left side.

Patients or Participants: 38yo with deep-infiltrative endometriosis involving the posterior uterus and rectosigmoid, seen on MRI.

Interventions: The patient underwent discoid resection with Connell suture closure. Adequacy of the repair is performed with flexible sigmoidoscopy.

Measurements and Main Results: The patient did well and was discharged on post-op day 1. At her post-op visit, she had complete resolutions of her symptoms.

Conclusion: When encountering large rectosigmoid endometriotic nodules, both discoid resections and colorectal segmental resections can be considered. Adequate dissection and evaluation must be performed to determine the feasibility of a discoid resection. For nodules too large to be excised with the EEA circular stapler, the double circular staple technique or the Connell suture closure can be considered. The Connell Suture closure does provide some advantages including being able to be used on lesions causing stenosis greater than 1/3 of the lumen, not being limited to 7-15cm from the anal verge, being able to visualize gross disease during dissection, and potentially being able to excise lesions greater than 4cm.