Nerve-sparing laparoscopic low anterior resection for rectal endometriosis in ten steps

Brought to you by the Society of Gynecologic Surgeons. Surgical treatment of deep infiltrating rectal endometriosis may require a low anterior resection, which should be performed only by a highly qualified surgeon. In this video, the authors outline a 10-step approach for performing a nerve-sparing laparoscopic low anterior resection:

1. Take down the white line of Toldt and mobilize the sigmoid colon.
2. Develop bilateral pararectal spaces and perform ureterolysis.
3. Develop the retrorectal space.
4. Confirm preservation of hypogastric nerves.
5. Develop the rectovaginal space.
6. Confirm nodule size and apply staplers proximally and distally.
7. Mobilize the splenic flexure and underlying bowel mesentery.
8. Apply circular stapler.
9. Perform air leak test.
10. Oversew any areas of weakness and inspect for hemostasis.