Background and Objectives: Augmented reality (AR) is increasingly being explored as an adjunct to image-guided minimally invasive surgery. In gynecology, its potential may be particularly relevant in fertility-preserving procedures, where the surgeon must balance adequate disease treatment with preservation of uterine architecture, reproductive anatomy, and future fertility potential. The aim of this review was to examine the current evidence on AR in minimally invasive reproductive gynecologic surgery, with a particular focus on myomectomy, adenomyomectomy, and endometriosis surgery, and to critically evaluate its limitations and future clinical role. Materials and Methods: A structured narrative review was conducted using PubMed/MEDLINE, Scopus, and Google Scholar from database inception to March 2026. Search terms included combinations of “augmented reality”, “mixed reality”, “image-guided surgery”, “myomectomy”, “fibroid”, “leiomyoma”, “adenomyosis”, “adenomyomectomy”, “endometriosis”, “deep infiltrating endometriosis”, “fertility-preserving surgery”, and “reproductive surgery”. Eligible studies included original clinical studies, pilot studies, feasibility studies, case series, case reports, technical reports, and translational studies directly relevant to reproductive gynecologic surgery. Results: The available evidence is limited and consists mainly of feasibility studies, proof-of-concept reports, technical notes, and small observational series. The most developed reproductive applications of AR are currently found in myomectomy and adenomyomectomy, where MRI-based uterine modeling has been used to improve lesion localization and support tissue-sparing dissection. In endometriosis surgery, AR remains less mature as an intraoperative tool but appears promising for lesion mapping, anatomical orientation, and dissection planning. Across procedures, AR appears most clinically plausible as a tool for technical refinement and complication prevention rather than as a technology with proven superiority in perioperative or reproductive outcomes. Conclusions: AR is a promising adjunct in fertility-preserving minimally invasive gynecologic surgery, particularly in anatomically complex procedures requiring accurate lesion localization and tissue-preserving dissection. However, the current evidence base remains insufficient to support routine implementation. Future research should determine whether AR can improve operative precision, reduce complications, preserve uterine integrity, and ultimately influence fertility-related outcomes.

OBJECTIVE:To present our preliminary experience with laparoscopic discoid excision for bowel endometriosis using hand-sewn bowel closure, without a circular transanal stapler. METHODS:This retrospective cohort study was based on prospectively collected data from Surgical Endoscopy Units in university-affiliated hospitals. Patients had deep endometriotic nodules involving the bowel, measuring >3 and ≤5 cm, and were scheduled for deep bowel shaving but considered unsuitable for standardized stapled discoid excision. Bowel shaving was initially attempted in all cases, and the decision to proceed to discoid excision was made intraoperatively. After excision, bowel closure was performed laparoscopically with a two-layer hand-sewn repair using 2-0 polyglycolic acid sutures. RESULTS:Ten patients were included. Mean duration of manual bowel suturing was 22 minutes (range, 18-35). Intraoperative complications were minimal. Time to first flatus ranged from 2 to 5 postoperative days, and oral feeding was delayed until bowel function returned. One patient developed severe febrile morbidity, successfully managed with antibiotics and parenteral nutrition. Follow-up ranged from 18 to 60 months. No severe complications, including anastomotic leakage, fistula, or major functional sequelae, occurred. Pain symptoms and quality of life improved in all patients. One patient developed recurrent bowel endometriosis and underwent segmental resection. Among four patients wishing to conceive, two achieved pregnancies, one spontaneously and one after in vitro fertilization; both delivered by caesarean section. CONCLUSION:Laparoscopic discoid excision with hand-sewn bowel closure may be a feasible conservative alternative for selected patients with larger bowel endometriotic nodules, potentially avoiding segmental resection.

OBJECTIVE:To present а rare case of complete uterine inversion in a nonpregnant young woman who was managed successfully laparoscopically. DESIGN:Video article with intraoperative narration and key surgical highlights. SUBJECTS:A 24-year-old patient with a history of laparotomic staging for a granulosa-cell ovarian tumor was admitted as an emergency to the gynecological oncology department of our hospital, with sudden onset of intractable uterine bleeding, caused by a necrotic, hemorrhagic mass, protruding from the vagina. EXPOSURE:Transvaginal excision of the lesion was attempted under laparoscopic control. At laparoscopy, complete uterine inversion was found. Μaneuvers to correct the inversion were unsuccessful. Hemostatic sutures were placed, and the patient was referred to our unit for further management. Histopathology suggested uterine adenomyoma. The uterine inversion was successfully reversed with a combination of laparoscopic and vaginal maneuvers after vertical anterior and posterior uterine incisions to divide the cervical constriction ring. The uterine cavity was opened, previous sutures were removed, and the uterus was reconstructed with resuturing in two layers. A prophylactic cervical cerclage tape was placed laparoscopically. MAIN OUTCOME MEASURES:Anatomical restoration of the uterus. RESULTS:At the six-month follow-up, the patient reported irregular cycles, without menorrhagia, and had a fairly normal-shaped uterus. CONCLUSION:Successful laparoscopic management of uterine inversion in nonpregnant patients with fertility preservation has been rarely reported. It represents a most challenging procedure when uterine preservation is at stake.

Background:The complexity of surgical management in women with deep infiltrating endometriosis (DIE) demands the optimisation of perioperative care protocols to ensure optimal postoperative outcomes. Objectives:This meta-analysis evaluates the effectiveness of Enhanced Recovery After Surgery (ERAS) protocols compared to conventional perioperative care in patients undergoing surgery for DIE. Methods:A systematic literature search was conducted in Medline, Scopus, Google Scholar, Cochrane CENTRAL, and ClinicalTrials.gov databases from inception till August 2024. Meta-analysis was performed with RevMan 5.4 software (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2020), with mean differences (MDs), pooled risk ratios (RR) and random-effects model. Quality assessment was performed using the Risk of Bias in Non-randomised Studies of Interventions and Risk of Bias tools. Main Outcome Measures:Primary outcomes assessed were postoperative length of hospital stay and readmission rates. Secondary outcomes included Clavien-Dindo grade I-II and grade III or higher complication rates. Results:Four comparative studies were included, encompassing a total of 1,662 patients. ERAS protocols significantly reduced the mean length of hospital stay [MD: -2.88 days; 95% confidence interval (CI): -5.34 to -0.41; P=0.02] without increasing readmission rates (RR: 1.13; 95% CI: 0.75-1.73; P=0.55). No significant differences were observed in Clavien-Dindo grade I-II complications (RR: 0.75; 95% CI: 0.49-1.16; P=0.20) or grade III or higher complications rates (RR: 0.60; 95% CI: 0.27-1.33; P=0.21). Conclusions:ERAS protocols appear to reduce the length of hospital stay without increasing complications or readmissions in DIE surgery. However, further large-scale randomised studies still needed to be conducted to confirm these findings. What is New?:The application of ERAS protocols is associated with better postoperative outcomes in patients undergoing major surgeries for DIE.

Laparoscopic pectopexy, facilitated by a cervical cerclage tape for the suspension of the vaginal vault, presents a feasible alternative to mesh sacrocolpopexy for the management of POP.

Background/Objectives: To assess the effectiveness of the levonorgestrel-releasing intrauterine device (LNG-IUD) compared to hysteroscopic resection for managing women with symptomatic cesarean scar defects (CSDs). Methods: This systematic review and meta-analysis followed PRISMA guidelines. A comprehensive search of four electronic databases was conducted to identify studies comparing LNG-IUD with hysteroscopic management for symptomatic CSDs. Studies reporting outcomes of bleeding and spotting days and effectiveness rates were included. Quality assessment was performed using the ROBINS-I and RoB-2 tools. Results: Three studies involving 344 patients met the inclusion criteria. At 6 months, LNG-IUD use significantly reduced total bleeding days (MD −4.13; 95% CI: −5.17 to −3.09; p < 0.00001) and spotting days (MD 1.90; 95% CI: 0.43 to 3.37; p = 0.01) compared to hysteroscopic treatment. By 12 months, LNG-IUD demonstrated superior effectiveness (OR 3.46; 95% CI: 1.53 to 7.80; p = 0.003), with fewer total bleeding days (MD −5.69; 95% CI: −6.55 to −4.83; p < 0.00001) and spotting days (MD 3.09; 95% CI: 1.49 to 4.69; p = 0.0002). Approximately 50% of LNG-IUD users experienced amenorrhea within 1 year. Conclusions: LNG-IUD offers a minimally invasive and effective alternative to hysteroscopic resection for women with symptomatic CSD and no desire for future pregnancies. Its role should be considered in clinical practice, but further research is needed to validate these findings and define its long-term benefits and limitations.

Intravenous leiomyomatosis (IVL) is a rare benign condition deriving from uterine leiomyomas, invading venous branches1 and sometimes extending into the pelvic vasculature, inferior vena cava, and right atrium, resembling malignant behavior2. This case involves a 38-year-old patient with localized IVL in the left uterine vein, identified preoperatively via MRI (Fig. 1A, B), while investigating a large fibroid with atypical ultrasound characteristics. Intraoperatively, the mass was confirmed and excised (Fig. 2A, B) Pathology confirmed the diagnosis (Fig. 3), and the uterus was reconstructed using overlapping flaps to reinforce the myometrial bed. Contrast-enhanced abdominal CT and echocardiography further confirmed the localized nature of the IVL. Consent for publication of these images was obtained from the patient.

Background/Objectives: Epithelial-Mesenchymal Transition (EMT) is the process by which epithelial cells acquire mesenchymal properties, which helps endometriotic cells migrate and invade. This study looks at the expression of E-CADHERIN, a critical epithelial marker, and miR-200b, an EMT regulator, in several types of endometriosis, including endometriomas and deep infiltrating endometriotic (DIE) nodules. Methods: We examined 19 individuals with endometriosis (9 with just endometriotic cysts and 10 with both DIE and endometriotic cysts) and 8 controls with benign gynecological abnormalities. Tissue samples were taken during laparoscopic surgery, and E-CADHERIN and miR-200b expression were measured using Real-Time PCR, with G6PD and U6 as controls. Results:E-CADHERIN expression was maintained in the eutopic endometrium of both ovarian and DIE types, but it was considerably reduced in endometriotic cysts, indicating heightened mesenchymal features. miR-200b was downregulated in the eutopic endometrium of ovarian endometriosis but upregulated in DIE. Endometriotic cysts in both groups had greater miR-200b expression than their corresponding eutopic endometrium. E-CADHERIN and miR-200b expression in DIE lesions was similar to that found in matched eutopic endometrium. Conclusions: The regulation of E-CADHERIN and miR-200b varies across ovarian and DIE lesions. The miR-200b-ZEB1 feedback loop is increased in DIE eutopic endometrium but downregulated in ovarian endometriosis. E-CADHERIN downregulation in endometriotic cysts indicates heightened mesenchymal dynamics, whereas DIE nodules have gene expression patterns similar to eutopic endometrium. These findings emphasize the distinct regulatory processes that govern endometriotic lesions.

Background:Caesarean scar pregnancy (CSP) is a pathologic entity with rising incidence over recent years. So far, there are many treatment methods and protocols suggesting surgical or medical interventions and their combinations. More and more laparoscopic surgery is applied to treat scar pregnancy with excellent results. A proper surgical strategy is a key point for optimal surgical outcome. Objectives:To present a standardised technique for the laparoscopic management of CSP. Participant:Patients with CSP having the indication of laparoscopic treatment. Intervention:The video presents a systematic approach of the laparoscopic treatment of CSP clearly divided into 10 steps: 1. Prepare the surgery; 2. Inspection of the pelvis; 3. Bladder dissection; 4. Preventive haemostasis; 5. Hysterotomy; 6. Evacuation of conception products; 7. Excision of niche scar tissue; 8. Evacuation of the uterine cavity; 9. Suturing of the uterine defect; 10. Removal of the uterine artery clips. The main outcome measures are the efficacy of the laparoscopic management of CSP and the postoperative uterine reconstruction in terms of ultrasonic measurement of the isthmic myometrial layer thickness. Patients are released from the hospital the day after the surgery, and a follow-up ultrasound is scheduled three months post-operatively. In the case presented in the video, the myometrial wall is increased from 3 mm preoperatively to 13 mm three months postoperatively. Conclusions:The main advantage of this technique is the ability to treat CSP, remove the uterine isthmocele, and reconstruct the lower uterine segment simultaneously. The 10 steps proposed in a logical sequence may shorten the surgery's learning curve and reduce possible complications. What is New?:We present a systematic approach that provides a safe and easily reproducible technique for managing CSP.

Background:Pelvic organ prolapse (POP) is a common gynaecological condition that can have an adverse impact on women's quality of life. Apical prolapse refers to the descending of the vaginal apex, uterus or cervix. Nowadays, laparoscopic sacropexy (LS) is the gold standard surgical method for the treatment of apical prolapse. However, defecation and urinary problems are often detected in patients who underwent LS. Laparoscopic pectopexy (LP) is a newer procedure for apical prolapse correction that uses the iliopectineal ligaments as fixation point for the surgical mesh. Objectives:To review the current evidence of the effectiveness and safety of LP and compare outcomes with other commonly used techniques for apical prolapse treatment. Methods:A literature search was carried out in MEDLINE, PubMed and ClinicalTrials.gov databases. The search was restricted to humans, female patients and currently used surgical procedures. Main Outcome Measures:The current recommendations from leading global scientific associations and prevailing trends in accepted clinical protocols. Results:LP was found to have shorter learning curve and operating times, better improvement in quality of life scores including sexual function and low complication rates. Conclusions:LP appears to be a viable alternative to LS. However, further prospective, comparative studies are necessary to evaluate its long-term effectiveness and morbidity. What is New?:This review summarises the evidence and current role of LP in the treatment of POP.

Background:Fortunately, interstitial pregnancies are a rare early pregnancy presentation, yet they can be challenging to managed and are associated with a high risk of intra-abdominal haemorrhage. Once detected, surgical laparoscopic resection can be the preferred management method for both patient safety and for definitive treatment. Objective:The video presents a new technique for laparoscopic resection of an interstitial pregnancy which enables the procedure to be effectively bloodless. Materials and Methods:We report on a new technique for laparoscopic cornual resection. As shown in the video, staying in the marginal zone may result in the enblock resection of the gestational sac. Using meticulous applications of bipolar energy and cutting with scissors in the marginal zone, the operation may be completed with almost no blood loss and minimal damage to the adjacent healthy myometrium. Results:The operation lasted 30 min with almost no blood loss. The patient had an uneventful recovery and was discharged on the first postoperative day. Conclusions:Staying in the marginal zone during dissection permits even less experienced laparoscopists to complete laparoscopic cornual resection with minimal blood loss concomitantly with minimal trauma to the adjacent myometrium.

Agenesis of inferior vena cava (AIVC) is an extremely rare congenital abnormality. In AIVC, venous flow from the lower extremities enter superior vena cava mainly through the azygous and hemiazygous system, forming anastomotic collateral vessels. A global increase in intra-abdominal pressure by the gravid uterus may further stress the collateral system, increase venous stasis and decrease venous return. We present the management of a 37-year old pregnant woman with AIVC who underwent caesarean section with norepinephrine infusion and general anaesthesia. She presented with shortness of breath when seated, episodes of dizziness while walking or sitting upright with subsequent tachycardia. Cardiac status was monitored using an arterial pulse contour CO monitor. We did not observe large fluctuations in CO, SV, MAP during induction and intubation as well as during delivery. We believe that administration of an infusion of norepinephrine from induction to anaesthesia through caesarean section contributed to this result. Sympathetic activation caused venoconstriction, which significantly increased venous return and maintained haemodynamic stability.

OBJECTIVE: To accumulate the currently available literature on the safety and efficacy of the use of knotless barbed sutures for the reconstruction of the uterine wall during laparoscopic myomectomy based on comparison with traditional suture studies. DATA SOURCES: We searched PubMed/Medline, Scopus, ClinicalTrials.gov, and Google Scholar up to February 29, 2024. METHODS OF STUDY SELECTION: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines and PICO criteria, we included all English-language, full-text articles that evaluated the perioperative outcomes of patients who had laparoscopic myomectomy and repair of the uterine wall defect with either barbed or traditional (extracorporeal or intracorporeal sutures). TABULATION, INTEGRATION, AND RESULTS: The application of barbed sutures resulted in significantly reduced operative time (2,111 patients, mean difference −12.04 minutes, 95% CI, −16.94 to −7.14, P <.001). This was also reflected when suturing time was separately analyzed (437 patients, mean difference −6.04 minutes, 95% CI, −7.43 to −4.65, P <.001) The mean difference in hemoglobin levels before and after surgery was significantly lower in the barbed suture group (1,277 patients, mean difference −0.40 g/dL, 95% CI, −0.72 to −0.09, P <.01) This was also observed in case of estimated blood loss, which was found to be lower in the barbed suture group (1,823 patients, mean difference −47.22 mL, 95% CI, −78.54 to −15.90, P =.003). Finally, the barbed suture group presented lower transfusion rates (1,217 patients, odds ratio 0.43, 95% CI, 0.19–1.00, P =.05). Concerning visual analog scale (VAS) score as evaluated by the surgeons for surgical difficulty, the control group proved to be more technically challenging compared with the barbed sutures group (184 patients, mean difference −1.66 95% CI, −2.37 to −0.94, P <.001). The VAS score for pain at 24 hours postoperatively, postoperative complication rates, and length of hospital stay were similar for both groups. Regarding reproductive outcomes, there was no difference in pregnancy, live birth, and birth complication rates. CONCLUSION: The use of barbed sutures during laparoscopic myomectomy presents many clinical benefits for the patient and the surgeon in terms of shorter operative and suturing time, less estimated blood loss, and ease of use. This pioneer technology may contribute to the expansion of laparoscopy on more complex myomectomies. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42023477304.

OBJECTIVE:Uterosacral ligament suspension (USLS) is one of the most frequently used operations for the restoration of apical support in women with uterovaginal prolapse. However, existing studies are inconclusive as to whether and which surgical access route is superior. The aim of the present meta-analysis is tentatively to compare the efficiency and the postoperative complications of laparoscopic USLS (L-USLS) and vaginal USLS (V-USLS), highlighting that current evidence remains inconclusive regarding the superiority of either surgical access route. DATA SOURCES:We performed a systematic literature review of 5 major databases (Medline, Scopus, Google Scholar Cochrane Central Register of Controlled Trials and Clinicaltrials.gov) from inception till April 2023. METHODS OF STUDY SELECTION:No language restrictions were applied. All comparative studies that compared L-USLS and V-USLS for the management of women with uterovaginal prolapse were included. TABULATION, INTEGRATION, AND RESULTS:Data from 6 retrospective cohort studies on 856 patients were extracted and analyzed. The methodological quality of the included studies was assessed using the risk of bias in nonrandomized studies of interventions tool and ranged between moderate to serious. The pooled results suggest that L-USLS was associated with a potentially decreased incidence of ureteral compromise (odds ratio [OR], 0.19; 95% confidence interval [CI] 0.04-0.89; p = .04) and seemingly lower objective (OR 0.47; 95% CI 0.23-0.97; p = .04) and subjective recurrence rates (OR 0.46; 95% CI 0.23-0.92; p = .03). There were no significant differences between the rates of postoperative pain from USLS sutures, postoperative pelvic hematomas, the suture exposure/granulation tissue formation, and the prolapse recurrence retreatment among the 2 groups. CONCLUSION:The present meta-analysis indicates that L-USLS is possibly associated with significantly fewer ureteral compromise rates and decreased subjective and objective recurrences rates compared to V-USLS. Nevertheless, given the limitations in data quality and heterogeneity of the included studies, these findings should be interpreted with caution. Large-scale randomized studies are essential to more definitively determine the relative merits of the laparoscopic versus vaginal approach.

OBJECTIVE:To accumulate the currently available literature on the safety and efficacy of the use of knotless barbed sutures for the reconstruction of the uterine wall during laparoscopic myomectomy based on comparison with traditional suture studies. DATA SOURCES:We searched PubMed/Medline, Scopus, ClinicalTrials.gov, and Google Scholar up to February 29, 2024. METHODS OF STUDY SELECTION:Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines and PICO criteria, we included all English-language, full-text articles that evaluated the perioperative outcomes of patients who had laparoscopic myomectomy and repair of the uterine wall defect with either barbed or traditional (extracorporeal or intracorporeal sutures). TABULATION, INTEGRATION, AND RESULTS:The application of barbed sutures resulted in significantly reduced operative time (2,111 patients, mean difference -12.04 minutes, 95% CI, -16.94 to -7.14, P <.001). This was also reflected when suturing time was separately analyzed (437 patients, mean difference -6.04 minutes, 95% CI, -7.43 to -4.65, P <.001) The mean difference in hemoglobin levels before and after surgery was significantly lower in the barbed suture group (1,277 patients, mean difference -0.40 g/dL, 95% CI, -0.72 to -0.09, P <.01) This was also observed in case of estimated blood loss, which was found to be lower in the barbed suture group (1,823 patients, mean difference -47.22 mL, 95% CI, -78.54 to -15.90, P =.003). Finally, the barbed suture group presented lower transfusion rates (1,217 patients, odds ratio 0.43, 95% CI, 0.19-1.00, P =.05). Concerning visual analog scale (VAS) score as evaluated by the surgeons for surgical difficulty, the control group proved to be more technically challenging compared with the barbed sutures group (184 patients, mean difference -1.66 95% CI, -2.37 to -0.94, P <.001). The VAS score for pain at 24 hours postoperatively, postoperative complication rates, and length of hospital stay were similar for both groups. Regarding reproductive outcomes, there was no difference in pregnancy, live birth, and birth complication rates. CONCLUSION:The use of barbed sutures during laparoscopic myomectomy presents many clinical benefits for the patient and the surgeon in terms of shorter operative and suturing time, less estimated blood loss, and ease of use. This pioneer technology may contribute to the expansion of laparoscopy on more complex myomectomies. SYSTEMATIC REVIEW REGISTRATION:PROSPERO, CRD42023477304.

Hypermobile Ehlers-Danlos syndrome (hEDS) is the most common type of EDS, characterized by joint hypermobility, frequent dislocations, and chronic pain. Genetic markers are not typically used in diagnosis. A 17-year-old clinically diagnosed with hEDS presented with recurrent lower abdominal pain, later attributed to intermittent partial adnexal torsion. Whole-genome sequencing revealed a missense mutation c.1691G > A (p. Arg564His) in the COL1A1 gene. She had undergone two exploratory laparotomies at ages 8 and 10 due to acute pain, resulting in a left adnexectomy and right detorsion with hydrosalpinx drainage. It was suspected that the recurrent adnexal torsion was linked to hEDS-related tissue elasticity, and so a laparoscopic right oophoropexy by shortening the utero-ovarian ligament was performed. At one-year follow-up, she was asymptomatic. This case highlights the potential connection between hEDS and adnexal torsion, which may contribute to chronic abdominal pain, often misattributed to other conditions, such as irritable bowel syndrome.

Endometriosis is a benign, estrogen-dependent gynecological condition with an uncertain exact pathogenetic mechanism. The aim of this study was to evaluate the potential differential expression of Insulin Growth Factor 1 (IGF-1) isoforms in deeply infiltrating endometriotic (DIE) lesions, in ovarian endometriomas, and in the eutopic endometrium of the same endometriosis patients and to compare their expression with that in the eutopic endometrium of women without endometriosis. A total of 39 patients were included: 28 with endometriosis, of whom 15 had endometriomas only, 7 had DIE nodules only, and 6 had both DIE and endometriomas, and 11 without endometriosis served as controls. We noticed a similar pattern of expression between IGF-1Ea and IGF-1Ec, which differed from that of the IGF-1Eb isoform, possibly implying differential biological actions of different isoforms in DIE subtypes. We observed a tendency of lower expression of IGF-1Ea and IGF-1Ec in endometriomas without DIE compared to endometriomas with concurrent DIE or in DIE nodules. In conclusion, differential expression of IGF-1 isoforms may indicate that DIE with its associated ovarian lesions and simple ovarian endometriosis should be considered as two forms of the disease developing under different molecular pathways.

Objective: To demonstrate the technique of discoid excision of bowel endometriosis followed by closure of the bowel defect using sutures, without the application of the transanal stapler device.Design: Stepwise demonstration of the technique with narrated video footage.Setting: Bowel endometriosis is a common pattern of deep endometriosis [1]. Discoid excision is 1 of the 3 surgical inter-ventions applied to manage this pathologic entity, with shaving and segmental resection being the other 2 [2]. When discoid excision is performed, a transanal stapler device is used for bowel closure in most cases [3,4]. Only a few studies so far have reported the application of sutures for this purpose [5]. This video highlights the technique of bowel suturing after dis-coid excision.Interventions: This video presents the technique of bowel discoid excision with the application of sutures to close the bowel defect (Supplemental Video 1). The key surgical steps are as follows: 1. Dissection of both ureters and development of pararectal spaces. 2. Recognition and preservation of the inferior hypogastric plexus and the hypogastric nerve. 3. Detachment of the nodule from the cervix. 4. Detachment of the nodule from the bowel, beginning with deep shaving and followed by discoid excision. 5. Thorough description of the bowel closure using 2 layers of Vicryl 3-0 sutures, the first being interrupted and the sec-ond continuous.Conclusion: The described technique of bowel closure using sutures may be a safe and effective alternative to the transanal stapler. Its advantage is that it can be performed when the pathology is located higher than 15 cm from the anal verge or the diameter of the nodule is more than 30 mm. Journal of Minimally Invasive Gynecology (2023) 30, 11-12. (c) 2022 AAGL. All rights reserved.