8711 Robotic Assisted Treatment of Deep Endometriosis, with Bowel and Ureteral Involvement

Abstract

<h3>Study Objective</h3> To demonstrate a minimal invasive approach to treat a patient with deep endometriosis causing renal exclusion. <h3>Design</h3> A surgical video highlighting anatomy and describing the steps of a multidisciplinary surgery. <h3>Setting</h3> Tertiary care hospital. The patient was in dorsal lithotomy position. <h3>Patients or Participants</h3> Female, 41-year-old, G1 with a previous cesarean 8 years ago. Suffering from chronic pelvic pain. After imaging tests, the patient was diagnosed with deep endometriosis, the main lesions being: a retrocervical lesion with involvement of the vagina and intestine, a lesion causing ureteral constriction and 2 intestinal lesions. <h3>Interventions</h3> At first, the patient was submitted to laparoscopic nephrectomy, with subsequent removal of the piece vaginally. Afterwards, she underwent robotic-assisted surgery, being performed hysterectomy with left parametrectomy and bilateral salpingectomy, adhesiolysis, resection of peritoneal lesions, intestinal shaving, appendectomy, left ureterectomy, ureterolysis and neurolysis. <h3>Measurements and Main Results</h3> The robotic assisted treatment of deep endometriosis was completed without complication. At post-operative follow-up, the patient was doing well without concerns. <h3>Conclusion</h3> In this video, we demonstrate a treatment for patients with stage 4 endometriosis, through minimally invasive surgery, with preservation of nerves and noble structures. Robotic surgery has proved to be an attractive strategy for treating these types of injuries, with good results, as shown in the video.