A review of deep infiltrative colorectal endometriosis treated robotically at a single institution

Abstract

Purpose/background Using robotic surgery, we report successful resection of deep invasive pelvic endometriosis with a multidisciplinary team of colorectal and gynecologic surgeons. Methods/interventions Fifteen cases of robotic‐assisted endometrial resections for deep invasive endometriosis were performed by a multidisciplinary team between 2013 and 2016. Results/outcomes The average total operative time of robotic endometrial extirpation was 342 minutes, and the average blood loss was 283 cc. There were no intraoperative complications and no conversion to laparotomy. Postoperative complications, including one superficial wound infection, four patients with pelvic abscesses, a bowel leak, and one rectovaginal fistula, occurred in five of 15 patients, three of which required percutaneous drainage and one required reoperation. All patients who followed up after surgery showed 100% dysmenorrhea resolution at one month (13 of 15 patients). Conclusion/discussion Deep infiltrating endometriosis is a complex disease associated with significant morbidity and requires highly trained, multidisciplinary team approach for safe and efficient excision.

Comparison of perioperative outcomes between standard laparoscopic and robot‐assisted approach in patients with rectosigmoid endometriosis

“…Common RALS advantages include more degrees of freedom in instrument mobility, a three-dimensional view, and improved surgeon dexterity and comfort, in particular in patients with elevated body mass index. 7,8 Although in several studies RALS has been advocated to be a safe, feasible, and effective alternative to S-LPS in RSE patients, [9][10][11] robust evidence regarding its clinical applicability is lacking. This prospective study sought to compare RALS and S-LPS in patients affected by RSE in terms of operative time (OT), operative room time, blood loss, length of stay, laparotomic conversion rate, perioperative complications, and endometriosis-related symptoms at 12-month follow up.…”

“…Although in several studies RALS has been advocated to be a safe, feasible, and effective alternative to S‐LPS in RSE patients, 9 , 10 , 11 robust evidence regarding its clinical applicability is lacking.…”

Colorectal Endometriosis: Ample data without definitive recommendations.

“…Certain themes have become clinically apparent, primarily that when approaching complex endometriosis patients with DIE of the bowel a multidisciplinary approach is paramount to an individual’s approach ( Nezhat et al, 2018 ; Graham et al, 2019 ). Ultimately, this multidisciplinary team often includes an experts review, or performance, of preoperative imaging, a pelvic surgeon trained in advanced surgery for endometriosis, and a colorectal surgeon.…”

“…Pelvic surgery for DIE of the bowel is a complex undertaking with many patient, surgical, and health system level variables to consider. We would like to reiterate that good scientific evidence suggests that patient outcomes are optimised when pelvic surgery for DIE of the bowel is performed in a multidisciplinary fashion in high volume centers focused on this disorder ( Graham et al, 2019 ; Nezhat et al, 2018 ). While rigorous study has been dedicated to the complex topic of the preferred surgical modality for DIE of the bowel there are serious limitations of the available data.…”

The role of robotic surgery for endometriosis

“…Among them, 15 patients received a bowel resection and the remaining 42 patients underwent only excision of endometriotic nodules. No intraoperative com-plications or conversion to laparotomy was reported [50].…”