Journal of minimally invasive gynecology · 2026
Ten-Step Approach to Ileocolonic Anastomosis With Natural Orifice Specimen Extraction (NOSE) for Deep Endometriosis.
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Bravo Ítalo, Paladugu Vinya, Denost Quentin, Roman Horace
Аннотация
OBJECTIVE: To present a standardized and reproducible ten-step approach to ileocolonic anastomosis with natural orifice specimen extraction (NOSE) in the context of laparoscopic or robotic surgery for deep endometriosis.
DESIGN: Surgical video article demonstrating a step-by-step technique.
SETTING: Tertiary referral center for advanced minimally invasive surgery for deep endometriosis.
INTERVENTIONS: Bowel endometriosis involves rectum and sigmoid in 90% of cases [1,2]. NOSE during these procedures have proven to be safe, better cosmesis, lower risk of incisión complications and faster recovery. [3,4]. Excision of deep endometriosis of the distal ileum or cecum can be performed in 10 successive steps [1]. (1) Cecum Mobilization: The lateral peritoneum is incised along the line of Toldt. (2) Dissection of Ileal Mesentery: The mesentery of the terminal ileum is divided up to the planned transection point. (3) Transection of the Ileum: The ileum is transected with a linear stapler at a disease-free segment (4) Removal of Pericecal and Pericolonic Fat: Fat surrounding the cecum and ascending colon is cleared to improve exposure of the bowel wall and facilitate further dissection. (5) Section of the Cecum: The cecum is transected distal to the lesion using a stapler. (6) Approximation of Ileum and Ascending Colon: The ileum and ascending colon are brought together in an isoperistaltic orientation, aligned without tension. (7) Incision of Ileum and Ascending Colon: Enterotomies are performed on the antimesenteric borders of both segments, adequately sized for stapler insertion. (8) Stapling of the Ileum and Colon: A side-to-side intracorporeal anastomosis is constructed using a linear stapler. (9) Suture of the Bowel Wall: The common enterotomy is closed with absorbable sutures, either continuous or interrupted. (10) Natural Orifice Specimen Extraction (NOSE): The specimen may be extracted transvaginally if a posterior colpotomy or hysterectomy has been performed, or transrectally following segmental rectal resection.
CONCLUSION: The ten-step technique presented in this video article provides a standardized method for performing ileocolonic anastomosis with natural orifice specimen extraction in selected cases of deep endometriosis. Dividing the procedure into systematic steps facilitates teaching and improves reproducibility. VIDEO ABSTRACT.
DESIGN: Surgical video article demonstrating a step-by-step technique.
SETTING: Tertiary referral center for advanced minimally invasive surgery for deep endometriosis.
INTERVENTIONS: Bowel endometriosis involves rectum and sigmoid in 90% of cases [1,2]. NOSE during these procedures have proven to be safe, better cosmesis, lower risk of incisión complications and faster recovery. [3,4]. Excision of deep endometriosis of the distal ileum or cecum can be performed in 10 successive steps [1]. (1) Cecum Mobilization: The lateral peritoneum is incised along the line of Toldt. (2) Dissection of Ileal Mesentery: The mesentery of the terminal ileum is divided up to the planned transection point. (3) Transection of the Ileum: The ileum is transected with a linear stapler at a disease-free segment (4) Removal of Pericecal and Pericolonic Fat: Fat surrounding the cecum and ascending colon is cleared to improve exposure of the bowel wall and facilitate further dissection. (5) Section of the Cecum: The cecum is transected distal to the lesion using a stapler. (6) Approximation of Ileum and Ascending Colon: The ileum and ascending colon are brought together in an isoperistaltic orientation, aligned without tension. (7) Incision of Ileum and Ascending Colon: Enterotomies are performed on the antimesenteric borders of both segments, adequately sized for stapler insertion. (8) Stapling of the Ileum and Colon: A side-to-side intracorporeal anastomosis is constructed using a linear stapler. (9) Suture of the Bowel Wall: The common enterotomy is closed with absorbable sutures, either continuous or interrupted. (10) Natural Orifice Specimen Extraction (NOSE): The specimen may be extracted transvaginally if a posterior colpotomy or hysterectomy has been performed, or transrectally following segmental rectal resection.
CONCLUSION: The ten-step technique presented in this video article provides a standardized method for performing ileocolonic anastomosis with natural orifice specimen extraction in selected cases of deep endometriosis. Dividing the procedure into systematic steps facilitates teaching and improves reproducibility. VIDEO ABSTRACT.