7572 Bladder Endometriosis: Robotic Surgery with 2 Low Accessory Ports - Two Case Reports

Abstract

<h3>Study Objective</h3> To show the diagnosis and safe robotic surgical approach of two cases of vesical endometriosis using only 2 low accessory ports <h3>Design</h3> A presentation of the surgical approach of two clinical cases, with narrated video footage. <h3>Setting</h3> Patient is placed in the semi-gynecological position. Robotic side docking set for left lateral pelvic using da Vinci Si platform. <h3>Patients or Participants</h3> The first case is a 37-year-old patient, nulligest, complaining of increased urinary frequency and urinary urgency with worsening of the menstrual period, who presented, on physical examination, a palpable 2cm nodule in the anterior vaginal wall. Nuclear magnetic resonance (MRI) confirmed a solid nodule in the midline of the posterior wall of the bladder, measuring 2 × 1.5 × 1.8 cm. The second case is a 37-year-old woman, nulligest, complaining of dysmenorrhea, chronic pelvic pain and infertility, refractory to clinical and surgical treatment for endometriosis. The MRI showed a solid hypoechoic nodule on the left posterior wall of the bladder dome, infiltrating the detrusor muscle, measuring 2.5 × 2.1 cm, without involvement of the bladder trigone. <h3>Interventions</h3> Two partial cystectomies performed entirely by robotic surgery for the treatment of vesical endometriosis using only two accessory punctures of 8mm with good surgical performance, less invasive and with better aesthetic results for the patient. In addition, urethral extraction can be a possibility to optimize surgical time and avoid widening the incisions. <h3>Measurements and Main Results</h3> The patients were discharged early, showing good clinical evolution, with excellent aesthetic results. <h3>Conclusion</h3> We can conclude that robotic surgery for bladder endometriosis with only two low accessory punctures is possible, being less invasive and aesthetically better for the patient. In addition, minimal resection of the bladder tissue must be sought and the trigone preserved to avoid damage to the nerves.