Robotic-assisted laparoscopy is a feasible method for resection of deep infiltrating endometriosis, especially in the rectosigmoid area.

Janika Hiltunen,Maarit Anttila,Hanna Sallinen,Auni Lindgren,Leea Keski-Nisula,Marja-Liisa Eloranta

doi:10.1177/03000605211032788

Abstract

ObjectiveThis study aimed to compare outcomes of mini-invasive surgical treatment of endometriosis, especially conventional laparoscopy with robotic-assisted laparoscopy, and to evaluate the quality of life.MethodsOne hundred three consecutive patients with endometriosis who had surgery from 2014 to 2017 owing to an indication of pain were enrolled in this retrospective study. The majority (n = 77, 75%) of patients underwent conventional laparoscopy and 18 (17%) had robotic-assisted laparoscopy. The quality of life was postoperatively assessed with a questionnaire.ResultsThe rates of parametrectomy (76% vs. 45%,) and rectovaginal resection (28% vs. 4%) were significantly higher in robotic-assisted laparoscopy than in laparoscopy. Additionally, the rate of bowel operations (50% vs. 17%), especially the shaving technique, was higher in robotic-assisted laparoscopy surgery than in laparoscopy (39% vs. 8%). There was no difference in the rate of postoperative complications between laparoscopy and robotic-assisted laparoscopy. Most (91%) of the patients who answered the questionnaire felt that surgical treatment had relieved their pain. In the laparoscopic and robotic-assisted groups, 88% of respondents felt that their quality of life had improved after surgery.ConclusionsThis study suggests that robotic-assisted laparoscopy is a feasible method to resect deep infiltrating endometriosis, especially in the rectosigmoid area.

Highlights

Endometriosis is an inflammatory, estrogen-dependent, chronic disorder in fertile-aged women
Data collected from medical files included prognostic, diagnostic and operative information, such as age, body mass index, operation date, preoperative symptoms, cancer antigen 125 (CA125) and human epididymis protein 4 (HE4) biomarkers, magnetic resonance imaging (MRI) findings, previous operations due to endometriosis, Clavien–Dindo classification,[19] operation technique, operative areas, hormonal treatments and postoperative contact with a clinic because of pain from endometriosis
We found that robotic-assisted laparoscopy was a feasible method for resection of deep infiltrating endometriosis (DIE), especially in the rectosigmoid area

Summary

Introduction

Endometriosis is an inflammatory, estrogen-dependent, chronic disorder in fertile-aged women. Endometriosis is defined as the presence of endometrial glands and stroma outside the uterine cavity. Endometriosis is considered as a benign disease, it can cause severe chronic pain and infertility, and decrease the quality of life.[1] Pharmacological treatments are the standard treatment for endometriosis.[2,3] when deep infiltrating endometriosis (DIE) decreases the quality of life because of associated pain or due to dysfunction of the bowels, bladder or ovaries, surgical treatment is necessary. Indications for surgical management are failure of medical management, the purpose of diagnosis, treatment of an adnexal mass or treatment of infertility.[4]

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Results

Conclusion