OBJECTIVE To demonstrate the use of a single-stapler technique during rectosigmoid resection in women with deep infiltrating endometriosis (DIE). DESIGN A step-by-step video demonstration of rectosigmoid resection and end-to-end anastomosis using two circularly placed sutures and one circular stapler. SETTING Institute for the Care of Mother and Child, Prague, Czech Republic. PATIENT(S) A 39-year-old woman presented with primary sterility and deep infiltrating endometriosis, and an EZIAN score of A2,B2,C3. A nodule was located 9 cm from the anus and was 38 × 9 mm in size. This included an intramural fibroma of 6 cm and a left-sided ovarian endometriotic cyst of 6 cm. Her pain on the visual analogue scale were dysmenorea 6, dyspareunia 5-6, dyschezie 7, dysuria 0, and acyclic pain 5. INTERVENTIONS The primary objective was to replace the linear-stapler resection with two simple, strictly circularly placed sutures, to cut the intestinal wall between them, and to form the end-to-end anastomosis with a circular stapler. The one-stapler technique consisted of the following steps: intestinal wall cleansing as in the limited segmental resection; placement of one strictly circular suture just below the DIE nodule, without fixation; placement of the first circular suture just below the DIE nodule, ideally with at least three full-thickness "bites" of the intestinal wall; placement of the second circular stitch approximately 2 cm below the first one in a similar manner (three full-thickness "bites"); interruption of the intestinal wall with a harmonic scalpel; end-to-end intestinal anastomosis with a circular stapler; and airtightness test of the anastomosis. This results in only one incision line and therefore a lower risk of leakage. Intestinal resection time was on average 10 minutes longer compared to that for the linear stapler technique. So far, we have successfully performed the procedure in 25 women. Perioperative leakage was observed in two of these 25 patients in the classical procedure group and in none of the 25 patients in the group with the one-stapler technique. There were no differences in C-reactive protein (CRP) on third and fifth postoperative days or in other complications such as bleeding and pyrexia). The cost of procedure is lowered by the decrease in the number of staplers from 3 to 1. The patients' postoperative follow-up was uneventful, and they were discharged from the hospital at the same time as the women in whom the classical stapler technique was performed. MAIN OUTCOME MEASURES(S) The primary outcome was the development of a new surgical approach to resection rectosigmoid endometriotic nodules that would decrease the number of incision lines on the intestine. The secondary outcome measures were peri- and postoperative complications (i.e., bleeding, intestinal leakage, postoperative infection, CRP), length of the surgery and hospitalization, and cost of the procedure. CONCLUSION Multiple incision lines following resection of the rectosigmoid colon and end-to-end anastomosis are risk factors for postoperative intestinal leakage. Therefore, a single incision line formed with two circular sutures, and one circular stapler may reduce the risk of postoperative complications and also financial expenses of the procedure. We believe that this method is suitable and easiest for nodules located less than 6 cm from the anal verge because of possible complications with angulation of linear stapler.

中文翻译：

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腹腔镜单吻合器技术在女性深部浸润性子宫内膜异位症的直肠乙状结肠切除术中的应用

目的 展示单吻合器技术在患有深部浸润性子宫内膜异位症 (DIE) 的女性直肠乙状结肠切除术中的应用。设计 使用两条圆形缝合线和一个圆形吻合器进行直肠乙状结肠切除术和端到端吻合术的分步视频演示。SETTING Institute for the Care of Mother and Child，捷克共和国布拉格。患者（S） 一名 39 岁女性，表现为原发性不孕和深部浸润性子宫内膜异位症，EZIAN 评分为 A2、B2、C3。结节位于距肛门 9 cm 处，大小为 38 × 9 mm。这包括一个 6 厘米的壁内纤维瘤和一个 6 厘米的左侧卵巢子宫内膜异位囊肿。她在视觉模拟量表上的疼痛是痛经 6 分，性交痛 5-6 分，排便困难 7 分，排尿困难 0 分，非周期性疼痛 5 分。干预 主要目的是用两条简单的、严格圆形缝合线代替线性吻合器切除术，切割它们之间的肠壁，并用圆形吻合器形成端对端吻合。单吻合器技术包括以下步骤：如有限节段切除术中的肠壁清洁；在 DIE 结节下方放置一根严格的圆形缝合线，无需固定；在 DIE 结节下方放置第一条环形缝合线，理想情况下至少有三个全层的肠壁“咬合”；以类似的方式将第二个圆形针迹放置在第一个圆形针迹下方约 2 厘米处（三个全层“咬合”）；用谐波手术刀中断肠壁; 用圆形吻合器进行端对端肠吻合；和吻合口的气密性试验。这导致只有一条切口线，因此泄漏的风险较低。与线性吻合器技术相比，肠切除时间平均长 10 分钟。到目前为止，我们已经成功地对 25 名女性进行了手术。在经典手术组的这 25 名患者中有 2 名观察到围手术期渗漏，而在单吻合器技术组的 25 名患者中没有观察到围手术期渗漏。术后第 3 天和第 5 天的 C 反应蛋白 (CRP) 或其他并发症（如出血和发热）没有差异。吻合器数量从3台减少到1台，降低了手术成本。患者术后随访顺利，她们与接受经典吻合器技术的女性同时出院。主要结果指标 主要结果是开发了一种新的手术方法来切除直肠乙状结肠子宫内膜异位结节，该方法将减少肠道切口线的数量。次要结局指标是围手术期和术后并发症（即出血、肠漏、术后感染、CRP）、手术和住院时间以及手术费用。结论直肠乙状结肠切除和端对端吻合术后的多条切口线是术后肠漏的危险因素。因此，由两条环形缝合线形成的单一切口线，一个圆形吻合器可以减少术后并发症的风险和手术的财务费用。我们认为这种方法适用于距离肛门边缘小于 6 cm 的结节，因为它可能会导致线性吻合器的角度出现并发症。