title: Management of deep infiltrating endometriosis by laparoscopic route with robotic assistance: 3-year experience.
abstract: OBJECTIVE
  To assess the feasibility of deep endometriosis surgery using robotic assistance, benefits and limits of this approach.
  
  
  METHODS
  Case-series study enrolling patients managed for deep infiltrating endometriosis (DIE) using robotic assistance in our department between September 2011 and March 2014 (NCT02294825). Self-questionnaires including pain and digestive symptoms were filled in preoperatively and 1 year after surgery.
  
  
  RESULTS
  Thirty-five patients were enrolled in the series. They represented 54% of patients managed for gynecological disease by laparoscopic route with robotic assistance during the study period, and 14% of patients managed for deep endometriosis in our department. Follow-up averaged 24±8 months, and no patient was lost to follow-up. Thirty-two patients had rectal involvement: rectal shaving was performed in 25 patients, disc excision in 3 and colorectal resection in 4. Three patients had bladder resection. Thirteen patients presented with deep endometriosis of the ureters: ureterolysis was performed in 11 of them, and resection of the ureter followed by reimplantation into the bladder in 2 patients. One major complication (Clavien IIIb) was recorded in a patient presenting with necrosis of the right ureter on postoperative day 5. Nine patients tried to conceive after surgery and 8 have already become pregnant (88.9%). One year after surgery, self-questionnaires revealed a significant decrease in pain symptoms and significant improvement in several item values of gastrointestinal standardized questionnaires.
  
  
  CONCLUSIONS
  Surgical management of DIE is feasible using robotic assistance. However, data available in the literature and our own experience do not definitively support the hypothesis of the superiority of robotic assistance in the management of DIE.
authors.affiliation: Department of gynecology and obstetrics, Rouen university hospital-Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France.
authors.forename: C
authors.initials: C
authors.lastname: Abo
authors.affiliation: Department of gynecology and obstetrics, Rouen university hospital-Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France; Research group 4308 "Spermatogenesis and Gamete Quality", IHU Rouen Normandy, IFRMP23, reproductive biology laboratory, Rouen university hospital, 76031 Rouen, France. Electronic address: horace.roman@gmail.com.
authors.forename: H
authors.initials: H
authors.lastname: Roman
authors.affiliation: Department of surgery, Rouen university hospital, 76031 Rouen, France.
authors.forename: V
authors.initials: V
authors.lastname: Bridoux
authors.affiliation: Department of surgery, Rouen university hospital, 76031 Rouen, France.
authors.forename: E
authors.initials: E
authors.lastname: Huet
authors.affiliation: Department of surgery, Rouen university hospital, 76031 Rouen, France.
authors.forename: J-J
authors.initials: JJ
authors.lastname: Tuech
authors.affiliation: Department of gynecology and obstetrics, Rouen university hospital-Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France.
authors.forename: B
authors.initials: B
authors.lastname: Resch
authors.affiliation: Department of gynecology and obstetrics, Rouen university hospital-Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France.
authors.forename: E
authors.initials: E
authors.lastname: Stochino
authors.affiliation: Department of gynecology and obstetrics, Rouen university hospital-Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France.
authors.forename: L
authors.initials: L
authors.lastname: Marpeau
authors.affiliation: Department of gynecology and obstetrics, Rouen university hospital-Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France.
authors.forename: B
authors.initials: B
authors.lastname: Darwish
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D011247:Pregnancy; D018873:Pregnancy Rate; D012002:Rectal Diseases; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D014570:Urologic Diseases / Q000601:surgery
keywords: Assistance robotique; Da Vinci; Deep endometriosis; Endométriose profonde; Rectal shaving; Robotic assistance; Shaving rectal; Ureterolysis; Urétérolyse