Asymptomatic rectal and bladder endometriosis: a case for robotic-assisted surgery.
OBJECTIVE
To evaluate the feasibility and safety of robot-assisted laparoscopic partial cystectomy for the treatment of rectal and bladder endometriosis.


METHODS
A 23 year-old female with history of infertility and pelvic pain was found to have a 4 cm bladder mass and rectal nodule on pelvic ultrasonography. Patient denied any other genitourinary symptoms. Cystoscopy and bladder mass biopsy revealed endometriosis. After failure to suppressive hormonal medical therapy a partial cystectomy and resection of a rectal lesion was performed with robotic assistance (da Vinci). The procedure included excision of an ovarian cyst and several peritoneal endometrioid implants.


RESULTS
Robotic-assisted (da Vinci) partial cystectomy with concomitant excision of endometrial nodules from the rectum and ovarian cyst was performed in 185 min. The rectal lesion was excised and primary closure of the rectum was performed. Patient had an uneventful postoperative course and hospital stay. Oral intake was started on postoperative day 1 and follow-up imaging revealed no bladder extravasation or fistula formation. The patient became pregnant 2 years later with "in vitro" fertilization procedure.


CONCLUSIONS
Robotic-assisted laparoscopic partial cystectomy with excision of rectal nodules for endometriosis can be safely performed.
Denver Health Medical Center, University of Colorado Health Sciences Center, Denver, Colorado 80204, USA.
Mario F
MF
Chammas
Fernando J
FJ
Kim
Aurelio
A
Barbarino
Nicolas
N
Hubert
Benoît
B
Feuillu
Alain
A
Coissard
Jacques
J
Hubert
D000328:Adult; D015653:Cystectomy; D004715:Endometriosis / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D010048:Ovarian Cysts / Q000150:complications / Q000601:surgery; D012002:Rectal Diseases / Q000150:complications / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D012371:Robotics; D001745:Urinary Bladder Diseases / Q000150:complications / Q000601:surgery*