Horace Roman, MD, PhD1, Adrian Lobontiu, MD2. 1Rouen University Hospital, 2PlasmaSurgical Ltd
Objective: To reportan original technique of rectal shaving using electrically neutral, pure plasma energy in deep endometriosis infiltrating the rectum.
Methods: The procedure is based on specific and unique properties of the plasma energy: the absence of lateral and underlying thermal spread, the microlayer vaporization allowing precise superficial ablation, and the kynetic energy using the flow to find and enhace the dissection of deep tissue planes with minimal thermal footprint. The nodule is detached from the rectum following a section plane that is tangential to the rectal wall. The residual rectal infiltration is progressively ablated by slowly painting the surface of shaved area with the plasma beam positioned at a distance of 5 mm from targeted area, which induces shallow necrosis of approximately 0.2-0.5 mm in depth. Patients managed from December 2012 to April 2014 using this procedure were prospectively included in a database (NCT02294825).
Results: There were 34 patients managed laparoscopically by rectal shaving using plasma energy. The diameter of the rectal area involved by the nodule was <=1cm in 7 cases (21%), 1-3 cm in 21 cases (62%) and >=3cm in 6 cases (18%). The height of the nodule from the anus varied between 5-10cm in 18 cases (53%) and 10-15 cm in 16 cases (47%). No intraoperative events were recorded. One patient (3%) with multiple previous surgical procedures presented with rectal fistulae responsible for peritonitis on day 21 after the surgery and underwent diverting colostoma. Three patients (9%) had transitory bladder dysfunction and underwent intermittent bladder catheterization for respectively 1, 10 and 12 weeks. There were recorded 3 patients (8%) with Clavien I complications, 8 (24%) with Clavien II, 1 (3%) with Clavien IIIa, 2 (6%) with Clavien IIIb, and 1 (3%) with Clavien IVa (one patient could present one or several complications). Conversely, 32 patients (94%) were free of Clavien III and IV complications.
Conclusion: Based on our experience, rectal shaving using plasma energy appears to allow for conservative, no touch, atraumatic surgery in deep endometriosis infiltrating the rectum, and might avoid postoperative complications and unfavorable functional outcomes related to colorectal resection.