Deep infiltrating colorectal endometriosis treated with robotic-assisted rectosigmoidectomy.
OBJECTIVE
Deep infiltrating pelvic endometriosis with bowel involvement is one of the most aggressive forms of endometriosis. Nowadays, robotic technology and telemanipulation systems represent the latest developments in minimally invasive surgery. The aim of this study is to present our preliminary results and evaluate the feasibility of robotic-assisted laparoscopic colorectal resection for severe endometriosis.


METHODS
Between September 2009 and December 2011, 10 women with colorectal endometriosis underwent surgery with the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, CA, USA). We evaluated the following parameters: short-term complications, clinical outcomes and long-term follow-up, pain relief recurrence rate, and fertility outcomes.


RESULTS
Extensive ureterolysis was required in 8 women (80%). Ovarian cystectomy with removal of the cystic wall was performed in 7 women (70%). Torus resection was performed in all women, with unilateral and bilateral uterosacral ligament resection in 1 woman (10%) and 8 women (80%), respectively. In addition to segmental colorectal resection in all cases, partial vaginal resection was necessary in 2 women (20%). An appendectomy was performed in 2 patients (20%). The mean operative time with the robot was 157 minutes (range, 90-190 minutes). The mean hospital stay was 3 days. Six patients had infertility before surgery, with a mean infertility time of 2 years. After a 12-month follow-up period, 4 women (67%) conceived naturally and 2 (33%) underwent in vitro fertilization.


CONCLUSIONS
We show that robotic-assisted laparoscopic surgery for the treatment of deep infiltrating bowel endometriosis is feasible, effective, and safe.
Hospital das Clinicas, Universidade de São Paulo, São Paulo, Brazil. rosaneme@uol.com.br
Rosa Maria
RM
Neme
Vladimir
V
Schraibman
Samuel
S
Okazaki
Gabriel
G
Maccapani
Winston Jenning
WJ
Chen
Cassia Danielle
CD
Domit
Oskar Grau
OG
Kaufmann
Arnold P
AP
Advincula
D000328:Adult; D012809:Colon, Sigmoid / Q000601:surgery*; D003108:Colonic Diseases / Q000473:pathology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004715:Endometriosis / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012002:Rectal Diseases / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012371:Robotics; D014513:Ureter / Q000601:surgery