In this preliminary study, fluorescence-guided laparoscopy appeared to help in separating the RVDIEN from the healthy rectal tissue, without rectal perforation. Moreover, this technique was helpful in deciding if the resection needed to be enlarged to the posterior vaginal fornix.

Dear Editor,The surgical resection of recto-vaginal deep infiltrating endometriosis nodules (RVDIEN) is challenging. It is the only treatment leading to long-term symptomatic improvement [1]. This video vignette aims to report an innovative technique of minimally invasive resection of RVDIEN.Our laparoscopic approach systematically starts with the dissection of the perirectal fascia [2] in order to extensively mobilize the posterior part of the rectum. The dissection continues laterally beyond the fibrosis caused by the RVDIEN. Finally, the rectum together with the RVDIEN en bloc is separated from the posterior vaginal cul-de-sac in order to perform a facilitated rectal shaving [3] far from the deep pelvis, or a colorectal resection.We included 10 consecutive patients in a preliminary analysis. Four had a colorectal resection and six had rectal shaving. The median operating time was 133 min: 192 min (107-261) for the colorectal resection and 119 min (76-177) for the rectal shaving (P = 0.2). The pain and the constipation significantly improved after a median follow-up of 4 (2-11) months. The median Endometriosis Health Profile -5 scores [4] were 24 (3-31) before and 1 (0-25) after surgery (P = 0.018). We registered no recto-vaginal fistula. Two major postoperative complications occurred: one uretero-vaginal fistula and one faecal incontinence. After a median followup of 22.5 (14-36) months, we observed no recurrence.This innovative technique appears, in our preliminary experience, to allow complete resection of RVDIEN, leading to a significant improvement of patients' symptoms and quality of life after surgery.

We report the case of a 61-year old woman presented with a voluminous centro-pelvic mass (22 × 17 cm), hydrothorax and ascites. Serum CA-125 was high (11,000 UI/ml). An explorative laparotomy located the mass between the rectum and the posterior wall of the uterus. The histological examination showed a primitive peritoneal tumor with serous and endometrioid differentiations. There was a left ovarian metastasis and both peritoneal and pleural liquids revealed no sign of malignancy. After the incomplete surgery, the hydrothorax and ascites decreased considerably. This association of Pseudo-Meigs’ syndrome with primitive peritoneal tumor is uncommon. To our knowledge this is the first case described through a Medline search