title: Robotic treatment of colorectal endometriosis: technique, feasibility and short-term results.
abstract: BACKGROUND
  Deep infiltrating endometriosis (DIE) is a complex disease that impairs the quality of life and the fertility of women. Since a medical approach is often insufficient, a minimally invasive approach is considered the gold standard for complete disease excision. Robotic-assisted surgery is a revolutionary approach, with several advantages compared with traditional laparoscopic surgery.
  
  
  METHODS
  From March 2010 to May 2011, we performed 22 consecutive robotic-assisted complete laparoscopic excisions of DIE endometriosis with colorectal involvement. All clinical data were collected by our team and all patients were interviewed preoperatively and 3 and 6 months post-operatively and yearly thereafter regarding endometriosis-related symptoms. Dysmenorrhoea, dyschezia, dyspareunia and dysuria were evaluated with a 10-point analog rating scale.
  
  
  RESULTS
  There were 12 patients, with a median larger endometriotic nodule of 35 mm, who underwent segmental resection, and 10 patients, with a median larger endometriotic nodule of 30 mm, who underwent complete nodule debulking by colorectal wall-shaving technique. No laparotomic conversions were performed, nor was any blood transfusion necessary. No intra-operative complications were observed and, in particular, there were no inadvertent rectal perforations in any of the cases treated by the shaving technique. None of the patients had ileostomy or colostomy. No major post-operative complications were observed, except one small bowel occlusion 14 days post-surgery that was resolved in 3 days with medical treatment. Post-operatively, a statistically significant improvement of patient symptoms was shown for all the investigated parameters.
  
  
  CONCLUSIONS
  To our knowledge, this is the first study reporting the feasibility and short-term results and complications of laparoscopic robotic-assisted treatment of DIE with colorectal involvement. We demonstrate that this approach is feasible and safe, without conversion to laparotomy.
authors.affiliation: Department of Gynecology, Policlinico Abano Terme, Piazza Cristoforo Colombo, 1- 35031 Abano Terme (PD), Italy. alfercoli@yahoo.it
authors.forename: A
authors.initials: A
authors.lastname: Ercoli
authors.forename: M
authors.initials: M
authors.lastname: D'asta
authors.forename: A
authors.initials: A
authors.lastname: Fagotti
authors.forename: F
authors.initials: F
authors.lastname: Fanfani
authors.forename: F
authors.initials: F
authors.lastname: Romano
authors.forename: G
authors.initials: G
authors.lastname: Baldazzi
authors.forename: M G
authors.initials: MG
authors.lastname: Salerno
authors.forename: G
authors.initials: G
authors.lastname: Scambia
mesh_terms: D000293:Adolescent; D000328:Adult; D004715:Endometriosis / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications; D012002:Rectal Diseases / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics; D016896:Treatment Outcome