Multifocal deep endometriosis with rectosigmoid involvement: laparoscopic segmental resection and transanal specimen extraction (NOSE technique)

Ramírez-Gonzales G.; García-Paredes S.; Caballero-Alvarado J.; Zavaleta-Corvera C. · Voprosy Ginekologii, Akusherstva i Perinatologii (2025) · DOI: 10.20953/1726-1678-2025-6-168-175

Resumen

Multifocal intestinal endometriosis is a rare and severe form of deep infiltrating endometriosis that can significantly impair a patient’s quality of life. While laparoscopic surgery is the current standard of care, the use of Natural Orifice Specimen Extraction (NOSE) offers an innovative, minimally invasive alternative that avoids additional abdominal incisions and their associated complications. This report presents a successful application of the NOSE technique in a patient with multiple intestinal nodules of deep endometriosis. We report the case of a 28-year-old woman with a five-year history of chronic pelvic pain, severe dys chronmenorrhea, deep dyspareunia, dyschezia, and constipation. Preoperative transvaginal ultrasound mapping and MRI revealed three endometriotic nodules involving the rectosigmoid and sigmoid colon, affecting a total segment of 84 mm. A laparoscopic segmental resection with transanal specimen extraction (NOSE technique) was performed without the need for colostomy or conversion to laparotomy. The postoperative course was uneventful, and the patient achieved complete symptom resolution at four-month follow-up. Conclusion. The NOSE technique offers significant benefits in the surgical management of multifocal intestinal endometriosis, including reduced surgical trauma, improved recovery, and superior cosmetic results. This case adds to the growing body of evidence supporting the use of NOSE in complex gynecologic surgical scenarios.

Instituciones: Universidad Científica del Sur; Universidad Privada Antenor Orrego