2937 Robotic Single-Site Surgery as a Feasible Method in Managing all Stages of Endometriosis with Chronic Pelvic Pain

Abstract

Study Objective To investigate the safety and feasibility of robotic single-site for surgical resection of stage I to IV endometriosis in chronic pelvic pain patients. Design A retrospective cohort study via chart review collected data. All procedures were performed by a single surgeon between January 2015 and April 2019. Setting An academic university hospital. Patients or Participants A total of 272 patients with chronic pelvic pain and pathology confirmed endometriosis were managed with surgical resection via the robotic single-site laparoscopy. All of the patients were chronic pelvic pain who incurred symptoms of dysmenorrhea, menorrhagia, deep dyspareunia, although other symptoms may be present such as dysphasia, lower back pain, urinary, or intestinal symptoms. Interventions All procedures were completed successfully with robotic single-site resection; however, an additional port was added in fourteen cases due to deep infiltrating endometriosis with colorectal, urinary tract involvement and extensive pelvic adhesion. Measurements and Main Results The median operative time was 110 min (range, 45-480 min), and the median blood loss was 50 mL (range, 15-300 mL). The length of hospital stay was less than 24 hours for 90.8% of patients (247/272). The incidence of complication was 5.9% (16/272). All but two surgeries had no severe complications, which included eight wound infection, one vaginal cuff dehiscence, four urinary tract infection and pelvic abscess. One patient with symptomatic bowel endometriosis nodule developed in the right abdominal wall and perineal hematoma after lower anterior bowel resection. The other patient, who had undergone a double ureteral malformation, ureteral endometriosis, and severe adhesion, had injured the left ureteral ten days after extensive pelvic and bladder nodule endometriosis resection. Conclusion Robotic single-site laparoscopic resection of endometriosis surgery appears to be a reasonably safe and feasible method for the surgical management of women with endometriosis. Adding a port is a good alternative if challenging cases encountered.