title: Peri-operative outcomes of patients with stage IV endometriosis undergoing robotic-assisted laparoscopic surgery.
abstract: We analyzed peri-operative outcomes of 80 patients who underwent robotic-assisted laparoscopic surgery and were diagnosed with stage IV endometriosis (revised American Society for Reproductive Medicine) between January 2007 and December 2010 at a tertiary gynecologic oncology referral center with a fellowship training program. Eligible women had a combination of one or more factors: pelvic mass, sub-acute or chronic pelvic pain, dysmenorrhea, dyspareunia, elevated serum CA-125, diagnosed with stage IV endometriosis at surgery with robotic-assisted gynecologic procedures using the da Vinci(®) Surgical System. The mean age was 43.7 ± 7.0 years, body mass index 27.5 ± 7.4 kg/m(2), and 23 (28.9%) patients had prior endometriosis surgery. Presenting symptoms included: chronic pelvic pain (48.8%), dysmenorrhea (40.3%), and dyspareunia (33.8%). Sixty-nine (86%) patients had pelvic masses (43 unilateral and 26 bilateral). Thirty-seven (46.3%) had elevated CA-125 levels (mean 97.9 ± 71.6 U/ml). Forty-eight (60%) underwent robotic-assisted laparoscopic hysterectomy (RALH)/bilateral salpingo-oophorectomy (BSO), 9 (11.3%) RALH/unilateral salpingo-oophorectomy (USO), 5 (6.3%) modified radical hysterectomy, and 10 (13%) USO or BSO only. Four (5%) had ovarian cystectomies with excision of endometriotic implants. Three (3.8%) underwent appendectomy and no patient required bowel resection. Four (5%) patients required conversion to laparotomy during the first 15 cases of this series [dense adhesions (3) and ureteral injury (1)]. Mean operative time was 115 ± 46 min, blood loss 88 ± 67 ml, and length of stay 1.0 ± 0.4 days. There were four (5%) complications (ureteral injury, cuff abscess, cuff hematoma, re-admission for nausea and vomiting secondary to narcotics) and no transfusions. One (1.3%) patient underwent a second surgery for pain (dyspareunia). Robotic-assisted surgery for stage IV endometriosis resulted in excellent pain relief, with few laparotomy conversions or complications during a robotic learning-curve experience.
authors.affiliation: Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute, 2501 N. Orange Ave., Suite 800, Orlando, FL, 32804, USA. lorna.brudie@yahoo.com.
authors.forename: Lorna A
authors.initials: LA
authors.lastname: Brudie
authors.affiliation: Obstetrics and Gynecology, IRCCS-Fondazione Policlinico San Matteo and University of Pavia, Pavia, 27100, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Gaia
authors.affiliation: Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute, 2501 N. Orange Ave., Suite 800, Orlando, FL, 32804, USA.
authors.forename: Sarfraz
authors.initials: S
authors.lastname: Ahmad
authors.affiliation: Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute, 2501 N. Orange Ave., Suite 800, Orlando, FL, 32804, USA.
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Finkler
authors.affiliation: Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute, 2501 N. Orange Ave., Suite 800, Orlando, FL, 32804, USA.
authors.forename: Glenn E
authors.initials: GE
authors.lastname: Bigsby
authors.affiliation: Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute, 2501 N. Orange Ave., Suite 800, Orlando, FL, 32804, USA.
authors.forename: Giselle B
authors.initials: GB
authors.lastname: Ghurani
authors.affiliation: Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute, 2501 N. Orange Ave., Suite 800, Orlando, FL, 32804, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Kendrick
authors.affiliation: Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute, 2501 N. Orange Ave., Suite 800, Orlando, FL, 32804, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Rakowski
authors.affiliation: Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute, 2501 N. Orange Ave., Suite 800, Orlando, FL, 32804, USA.
authors.forename: Jessica H
authors.initials: JH
authors.lastname: Groton
authors.affiliation: Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute, 2501 N. Orange Ave., Suite 800, Orlando, FL, 32804, USA.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Holloway
keywords: Endometriosis; Pelvic mass; Pelvic pain; Peri-operative outcomes; Robotic surgery