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IFEM Endo Academy Research & Innovation Section · March 2026

  • 4 days ago
  • 4 min read

Teaching Endometriosis Surgery in the Video Era 


The IFEM Endo Bordeaux Clinical Research Team


Surgical video, when published in a peer-reviewed journal, currently represents a powerful tool to disseminate a technique, standardize an approach, and train surgeons worldwide. IFEM Endo Bordeaux has been committed to this path for several years, with publications in the specialty's most prestigious journals.

A Scientific article in its own right

In minimally invasive surgery, words are no longer always sufficient to describe the precision of a gesture or the organization of an operative step. Today, the video article published in leading journals (such as Fertility and Sterility or the Journal of Minimally Invasive Gynecology) has become one of the most effective tools for disseminating a technique and harmonizing surgical practices on a global scale.

These publications are not simple tutorials: they are subject to rigorous peer review, require ethical validations, and are officially indexed in databases such as PubMed.

For a center where more than 400 surgeons from six continents have completed training, video publication is the natural extension of IFEM Endo's pedagogical mission: it ensures that techniques developed in Bordeaux do not remain confined to a single operating room. Furthermore, it has been demonstrated that live surgery broadcast from the surgeon's routine operating theater is not associated with an increased risk of complications¹, confirming that pedagogical dissemination and safety of care are perfectly compatible.



Focus on the latest advances


Ten-Step Approach to Ileocolonic Anastomosis with Natural Orifice Specimen Extraction (NOSE) for Deep Endometriosis (Bravo, Paladugu, Denost, Roman — JMIG 2026)²


While digestive endometriosis most often affects the rectum and sigmoid, involvement of the terminal ileum and cecum sometimes requires segmental resection with ileocolonic anastomosis. The NOSE technique (Natural Orifice Specimen Extraction), which allows the extraction of the surgical specimen through the vagina or rectum without additional parietal incision, is gradually becoming established in this context. The IFEM Endo team participated in a 2022 publication involving a series of 50 patients operated on using NOSE for colorectal endometriosis³.

Dr. Ítalo Bravo co-authored this video article with Prof. Horace Roman, breaking down the procedure into ten successive steps, entirely performed endoscopically. As the authors conclude, dividing the procedure into systematic steps facilitates teaching and improves reproducibility.


Parametrial Endometriosis with Pelvic Nerve Involvement: Two Types, Two Approaches (Samartzis, Kalaitzopoulos, Burla, Roman — JMIG 2026)⁴


Deep endometriosis of the parametrium with sacral nerve infiltration is one of the most disabling forms of the disease: sciatica, pudendal neuralgia, lower limb paresthesia, and bladder or rectal dysfunction are its manifestations. In collaboration with the IFEM Endo team, a series of 52 patients operated on for these forms was published in 2021, showing significant improvement in pain after surgery⁵.

This video article, the result of a collaboration between Prof. Roman and Drs. Samartzis and Kalaitzopoulos, proposes a classification distinguishing two anatomical types of parametrial nodules — medial versus lateral — involving different nerve structures and requiring distinct surgical approaches. This work adds to the "butterfly method," stemming from their 2024 collaboration⁶.


A consistent line of video publications

These two JMIG 2026 publications follow an established tradition. The IFEM Endo team had already published the ten-step endometrioma sclerotherapy technique in Fertility and Sterility (Crestani, Merlot, Dennis, Roman, 2022)⁷, the excision of deep endometriosis nodules of the sciatic nerve in the Journal of Visceral Surgery (Roman, Crestani, Merlot, 2022)⁸, and the colorectal disc excision technique in Colorectal Disease (Sandera, Samartzis, Roman et al., 2025)⁹. Added to these publications is the video article published in 2025 in the JMIG by Roman, Celhay, Dennis, Merlot, dedicated to the robotic excision of deep endometriosis infiltrating the superior gluteal nerve¹⁰.

Each of these videos is a scientific contribution accessible to any surgeon. This is precisely IFEM Endo's ambition: to disseminate innovations internationally, standardize practices to improve patient safety, and train the next generation of specialized surgeons.



Each of these videos is a scientific contribution accessible to any surgeon. This is precisely IFEM Endo's ambition: to disseminate innovations internationally, standardize practices to improve patient safety, and train the next generation of specialized surgeons.


References

  1. Roman H, Prosszer M, Marabha J, et al. Live surgery of colorectal endometriosis broadcasted from a surgeon’s routine operating theater is not associated with higher complications rate. Acta Obstet Gynecol Scand. 2021;100(12):2161-2168.

  2. Bravo Í, Paladugu V, Denost Q, Roman H. Ten-Step Approach to Ileocolonic Anastomosis with Natural Orifice Specimen Extraction (NOSE) for Deep Endometriosis. J Minim Invasive Gynecol. 2026 Feb 12:S1553-4650(26)00091-9. doi: 10.1016/j.jmig.2026.01.063. 

  3. Grigoriadis G, Dennis T, Merlot B, et al. Natural orifice specimen extraction colorectal resection for deep endometriosis: a 50 case series. J Minim Invasive Gynecol. 2022 Sep;29(9):1054-1062.

  4. The optimal surgical approach for deep infiltrating endometriosis involving pelvic nerves (type 1 and 2) Nicolas Samartzis, M.D.1, Dimitrios Rafail Kalaitzopoulos, M.D.1, Laurin Burla, M.D.1, Horace Roman, M.D.2,3

  5. Roman H, Merlot B, Darwish B, et al. Postoperative outcomes after surgery for deep endometriosis of the sacral plexus and sciatic nerve: a 52-patient consecutive series. J Minim Invasive Gynecol. 2021;28(7):1375-1383.

  6. Samartzis N, Kalaitzopoulos DR, Burla L, Angheluta M, Merlot B, Roman H. Robotic techniques in endometriosis: six steps for excision of rectovaginal nodules — the butterfly method. Fertil Steril. 2024;122(6):1157-1159.

  7. Crestani A, Merlot B, Dennis T, Roman H. Laparoscopic sclerotherapy for an endometrioma in 10 steps. Fertil Steril. 2022;117(5):1102-1103.

  8. Roman H, Crestani A, Merlot B. Excision of deep endometriosis nodules of the sciatic nerve using robotic assistance, with video. J Visc Surg. 2022;159:74-76.

  9. Sandera P, Samartzis N, Kalaitzopoulos DR, et al. Colorectal surgery for endometriosis: a comprehensive step-by-step approach of the disc excision technique. Colorectal Dis. 2025;27(1):e17218.

  10. Roman H, Celhay O, Dennis T, Merlot B. Robotic excision of deep endometriosis involving the superior gluteal nerve. J Minim Invasive Gynecol. 2025. doi:10.1016/j.jmig.2025.08659


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