PMC3015542_01
Cul de sac with rectum adherent to the back of the cervix.
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F1
We found the rectum tethered to the back of the cervix and the left pelvic side wall with incomplete obliteration of the pouch of Douglas (Figure 1).
After identifying rectal endometriosis, the affected loop of rectum is dissected.
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F2
The mesorectum was dissected using the Ultracision Harmonic scalpel (Ethicon, USA), exposing a 6-cm length of rectum that incorporated the diseased area (Figure 2).
The CEEA device is inserted up the rectum; the anvil is removed and held proximal to the diseased segment before the rectal segment is excised.
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F3
By unscrewing the handle, the anvil of the CEEA device was made visible through the rectal wall, and the shaft was grasped by using a soft bowel grasper (Figure 3).
The rectal segment is excised using the Endo-GIA stapler.
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F4
An EndoGIA Universal stapling device (Tyco Healthcare, USA) was used to transect the rectum above and below the diseased area (Figure 4).
The point of the shaft of the anvil is pushed through the proximal end of the colon.
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F5
The point of the shaft of the anvil was then pushed through the transverse staple line on the proximal end of the colon (Figure 5).
The anvil is reattached to the CEEA device before being fired and removed.
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F6
The CEEA device was reinserted through the anus, and the anvil reattached (Figure 6).