title: Robot-assisted surgery for the radical treatment of deep infiltrating endometriosis with colorectal involvement: short- and mid-term surgical and functional outcomes.
abstract: OBJECTIVE
  Sexual and urinary dysfunctions are complications in radical treatment of deep infiltrating endometriosis (DIE) with colorectal involvement. The aim of this article is to report the preliminary results of our single-institution experience with robotic treatment of DIE, evaluating intraoperative and postoperative surgical outcomes and focusing on the impact of this surgical approach on autonomic functions such as urogenital preservation and sexual well-being.
  
  
  METHODS
  From January 2011 through December 2013, a case series of 10 patients underwent robotic radical treatment of DIE with colorectal resection using the da Vinci System. Surgical data were evaluated, together with perioperative urinary and sexual function as assessed by means of self-administered validated questionnaires.
  
  
  RESULTS
  None of the patients reported significant postoperative complications. Questionnaires concerning sexual well-being, urinary function, and impact of symptoms on quality of life demonstrated a slight worsening of all parameters 1 month after surgery, while data were comparable to the preoperative period 1 year after surgery. Dyspareunia was the only exception, as it was significantly improved 12 months after surgery.
  
  
  CONCLUSIONS
  Robot-assisted surgery seems to be advantageous in highly complicated procedures where extensive dissection and proper anatomy re-establishment is required, as in DIE with colorectal involvement. Our preliminary results show that robot-assisted surgery could be associated with a low risk of complications and provide good preservation of urinary function and sexual well-being.
authors.affiliation: General Surgery Unit, Department of Oncology Transplantation and New Technologies, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.|EndoCAS (Center of Computer Assisted Surgery), University of Pisa, Pisa, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Morelli
authors.affiliation: 2nd Department of Obstetrics and Gynecology, Santa Chiara Hospital, Pisa, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Perutelli
authors.affiliation: General Surgery Unit, Department of Oncology Transplantation and New Technologies, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy. palmeri.matteo@gmail.com.
authors.forename: Matteo
authors.identifier: http://orcid.org/0000-0002-9343-278X
authors.initials: M
authors.lastname: Palmeri
authors.affiliation: General Surgery Unit, Department of Oncology Transplantation and New Technologies, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Guadagni
authors.affiliation: General Surgery Unit, Department of Oncology Transplantation and New Technologies, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
authors.forename: Maria Donatella
authors.initials: MD
authors.lastname: Mariniello
authors.affiliation: General Surgery Unit, Department of Oncology Transplantation and New Technologies, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
authors.forename: Gregorio
authors.initials: G
authors.lastname: Di Franco
authors.affiliation: Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: Cela
authors.affiliation: Obstetrics and Gynecology Unit, Department of Fetal-Maternal Medicine, "G. da Saliceto" Hospital, Piacenza, Italy.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Brundu
authors.affiliation: 2nd Department of Obstetrics and Gynecology, Santa Chiara Hospital, Pisa, Italy.
authors.forename: Maria Giovanna
authors.initials: MG
authors.lastname: Salerno
authors.affiliation: General Surgery Unit, Department of Oncology Transplantation and New Technologies, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Di Candio
authors.affiliation: EndoCAS (Center of Computer Assisted Surgery), University of Pisa, Pisa, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Mosca
mesh_terms: D000328:Adult; D003106:Colon / Q000601:surgery*; D004715:Endometriosis / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D019990:Perioperative Care; D011788:Quality of Life; D012007:Rectum / Q000601:surgery*; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome; D014554:Urination
keywords: Colorectal resection; Deep infiltrating endometriosis; Nerve-sparing surgery; Robotic surgery; Sexual dysfunction; Urinary dysfunction