Rectal shaving using PlasmaJet in deep endometriosis of the rectum

Original Video Article

Rectal shaving using PlasmaJet in deep endometriosis of the rectum

Author:
Horace Roman, M.D., Ph.D., Rouen University Hospital, France

Capsule:
The PlasmaJet is a valuable tool in performing rectal shaving, owing to the lack of lateral thermal spread, its dissection ability enhanced by kinetic energy, and its ablative effect on tissue.

Objective: To report an original technique of rectal shaving using the PlasmaJet system (Plasma Surgical, Inc., Roswell, GA) for the management of deep endometriosis of the rectum.
Design: Video demonstration of a new surgical technique.
Setting: Hospital.
Patient: A 34-year-old primipara with a deep endometriosis involving the vagina and the mid-rectum over 30mm.
Intervention: An original technique of rectal shaving.
Main Outcome Measures: The procedure is based on specific properties of PlasmaJet: the lack of lateral thermal spread around the jet of plasma making the dissection on contact of rectal wall safe, the precise ablative property allowing for in situ ablation of rectal endometriosis implants, and the kinetic energy enhancing the dissection of subperitoneal spaces. The steps of the technique and the role of PlasmaJet are emphasized. The surgical technique report in anonymous patients is exempted from ethical approval by the IRB.
Results: The patient’s outcome was uneventful, and colorectal complaints were completely relieved 1 week after surgery. Since November 2012, we have employed this technique in 18 patients, with only favorable outcomes.
Conclusions: The technique described in this video article may represent a step toward a more complete removal of endometriotic implants and better colorectal outcomes.

References
1. Roman H, Vassilieff M, Gourcerol G, Savoye G, Leroi AM, Marpeau L, et al. Surgical management of deep infiltrating endometriosis of the rectum: pleading for a symptom-guided approach. Hum Reprod 2011; 26: 274-81.
2. Donnez J, Squifflet J. Complications, pregnancy and recurrence in a prospective series of 500 patients operated on by the shaving technique for deep rectovaginal endometriotic nodules. Hum Reprod 2010; 25: 1949-58.
3. Donnez J, Nisolle M, Casanas-Roux F, Bassil S, Anaf V. Rectovaginal septum, endometriosis or adenomyosis: laparoscopic management in a series of 231 patients. Hum Reprod 1995; 10: 630-5.
4. Roman H, Vassilieff M, Tuech JJ, Huet E, Savoye G, Marpeau L, Puscasiu L. Postoperative digestive function after radical versus conservative surgical philosophy for deep endometriosis infiltrating the rectum. Fertil Steril 2013; http://dx.doi.org/10.1016/j.fertnstert.2013.01.131
5. Roman H, Tuech JJ, Slim K, Canis M. Functional Outcomes of Surgical Management of Deep Endometriosis Infiltrating the Rectum (ENDORE). NCT01291576 Available on http://clinicaltrials.gov/ct2/show/NCT01291576?term=NCT01291576&rank=1; 2011.

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