Case Reports: Two Successful Pregnancies Following Robotic Resection of Stage IV Endometriosis

Abstract

Listen

Translate article

Successful term pregnancies following surgical management of Stage IV endometriosis is reported between 4-10%. PubMed and the Cochrane Review showed no publications on successful pregnancies following robotic enhanced pelviscopy for the treatment of Stage IV endometriosis. Case reports of 2 patients. Patients of a solo private practice with surgery at a community hospital. MS is a 20 year old G0 diagnosed laparoscopically with stage 1 endometriosis that was ablated. KW is a 29 year old G2P1Ab1 diagnosed laparoscopically with Stage IV endometriosis and no operative management performed. MS was started on OCs but developed worsening pelvic pain and bilateral ovarian complex masses. Repeat laparoscopy demonstrated Stage IV endometriosis with appendiceal involvement. She later consented to daVinci assisted pelviscopy with resection of bilateral ovarian endometriomas, and obliterated cul-de-sac and appendectomy. KW was treated with 6 months of Depot Lupron with no change in the size of the endometriomas and pelvic pain continued. Pelviscopy was done with drainage of bilateral ovarian endometriomas and limited pelvic adhesiolysis due to the obliterated cul-de-sacs. She was retreated with 6 more months of Depot Lupron. Two years later, she still had not conceived, her pelvic pain increased, and the endometriomas returned. KW then underwent daVinci assisted resection of the obliterated cul-de-sac and bilateral ovarian endometriomas. Also performed were lysis of bilateral peritubal adhesions, a left neosalpingotomy, and uterine suspension. MS conceived 3 months postoperatively and delivered at term. KW used OCs for 6 months, then conceived 1 year postoperatively and then delivered at term. With robotics, the superior optics and maneuverability allow for more extensive and thorough dissection with minimal morbidity; and a better way of helping patients cope with the difficulties of endometriosis and achieving pregnancies.