EP2026 - Early perioperative and postoperative outcomes of laparoscopic segmental resection with transvaginal NOSE for rectal endometriosis: A single-center case series

Purpose/Background: Deep rectal endometriosis poses significant surgical challenges, frequently necessitating segmental resections. Traditional abdominal extraction can increase morbidity. NOSE offers a minimally invasive technique that may improve short-term outcomes. We aimed to evaluate the feasibility and safety of laparoscopic segmental resection with transvaginal NOSE in a series of patients

Methods/Interventions: A retrospective descriptive case series was conducted between 2024 and 2025. Five patients with rectal endometriosis underwent laparoscopic segmental rectal resection with transvaginal specimen extraction (NOSE) at Hospital San José, Bogotá, performed collaboratively by colorectal surgeons and gynecologists.

Results/Outcomes: A total of five patients with rectal endometriosis were treated collaboratively by colorectal surgeons and gynecologists at Hospital San José, Bogotá. The mean hospital stay was 4.4 days (range 3-6). Three patients were overweight, one had class I obesity, and one had a normal BMI. Three had one previous vaginal delivery and two were nulliparous; none used hormonal contraceptives or smoked. One patient had cardiovascular comorbidities. All cases showed exclusive rectal involvement on endoanal ultrasound; one presented extrinsic compression and another endoluminal compromise on colonoscopy. All underwent laparoscopic segmental rectal resection. Lesions were located in the upper rectum in two patients, mid rectum in two, and were multifocal in one. Four patients had invasion up to the muscularis layer and one up to the serosa. No stomas were required. Ovarian preservation was achieved in four patients, and the uterus was preserved in all cases. No postoperative complications occurred according to the Dindo-Clavien classification; specifically, there were no infections, bleeding events, rectovaginal fistulas, ureteral injuries, rectal stenosis, or anastomotic leaks.

Conclusion/Discussion: Laparoscopic segmental resection with transvaginal NOSE for rectal endometriosis was feasible and safe in this small series, with no postoperative complications, short hospital stays, and high rates of organ preservation. These results align with published series supporting NOSE as a minimally invasive alternative in specialized centers. Larger studies with longer follow-up are needed to confirm these favorable outcomes.

Rectal compromise location
Organ preservation