Peri-operative outcomes of patients with stage IV endometriosis undergoing robotic-assisted laparoscopic surgery

Abstract

We analyzed peri-operative outcomes of 80 patients who underwent robotic-assisted laparoscopic surgery and were diagnosed with stage IV endometriosis (revised American Society for Reproductive Medicine) between January 2007 and December 2010 at a tertiary gynecologic oncology referral center with a fellowship training program. Eligible women had a combination of one or more factors: pelvic mass, sub-acute or chronic pelvic pain, dysmenorrhea, dyspareunia, elevated serum CA-125, diagnosed with stage IV endometriosis at surgery with robotic-assisted gynecologic procedures using the da Vinci(®) Surgical System. The mean age was 43.7 ± 7.0 years, body mass index 27.5 ± 7.4 kg/m(2), and 23 (28.9%) patients had prior endometriosis surgery. Presenting symptoms included: chronic pelvic pain (48.8%), dysmenorrhea (40.3%), and dyspareunia (33.8%). Sixty-nine (86%) patients had pelvic masses (43 unilateral and 26 bilateral). Thirty-seven (46.3%) had elevated CA-125 levels (mean 97.9 ± 71.6 U/ml). Forty-eight (60%) underwent robotic-assisted laparoscopic hysterectomy (RALH)/bilateral salpingo-oophorectomy (BSO), 9 (11.3%) RALH/unilateral salpingo-oophorectomy (USO), 5 (6.3%) modified radical hysterectomy, and 10 (13%) USO or BSO only. Four (5%) had ovarian cystectomies with excision of endometriotic implants. Three (3.8%) underwent appendectomy and no patient required bowel resection. Four (5%) patients required conversion to laparotomy during the first 15 cases of this series [dense adhesions (3) and ureteral injury (1)]. Mean operative time was 115 ± 46 min, blood loss 88 ± 67 ml, and length of stay 1.0 ± 0.4 days. There were four (5%) complications (ureteral injury, cuff abscess, cuff hematoma, re-admission for nausea and vomiting secondary to narcotics) and no transfusions. One (1.3%) patient underwent a second surgery for pain (dyspareunia). Robotic-assisted surgery for stage IV endometriosis resulted in excellent pain relief, with few laparotomy conversions or complications during a robotic learning-curve experience.

‘Money for nothing’. The role of robotic-assisted laparoscopy for the treatment of endometriosis

“…Among them, 11 studies were non-comparative, i.e. included women operated with RAL only (Abo et al, 2016;Bedaiwy et al, 2013;Brudie et al, 2012;Collinet et al, 2014;Ercoli et al, 2012;Lim et al, 2011;Morelli et al, 2016;Neme et al, 2013;Nezhat et al, 2011;Pellegrino et al, 2015;Siesto et al, 2014), whereas six studies were comparative, i.e. compared two series of women operated with RAL and SL (Cassini et al, 2014;Dulemba et al, 2013;Magrina et al, 2015;Nezhat et al, 2010Nezhat et al, , 2015Nezhat and Sirota, 2014).…”

“…Available data from non-comparative series of women that were operated using RAL, show that this treatment of endometriosis is feasible and safe. These non-comparative studies reported a low rate of complications and a significant reduction of pain at a mean follow-up of 15 months (Abo et al, 2016;Brudie et al, 2012;Collinet et al, 2014;Ercoli et al, 2012;Morelli et al, 2016;Neme et al, 2013;Nezhat et al, 2011;Siesto et al, 2014). The surgical procedures successfully performed by RAL include radical treatment of the most severe, surgically demanding and painful (Vercellini, 1997) form of the disease, which is deeply infiltrating endometriosis involving the bowel or the urinary tract.…”

“…The characteristics of the patients and the perioperative data of the non-comparative studies are reported in Table 2. Four studies were prospective (Abo et al, 2016;Lim et al, 2011;Neme et al, 2013;Pellegrino et al, 2015) and seven were retrospective (Bedaiwy et al, 2013;Brudie et al, 2012;Collinet et al, 2014;Ercoli et al, 2012;Morelli et al, 2016;Nezhat et al, 2011;Siesto et al, 2014). In total, 445 patients were evaluated, with a mean age of 39 years.…”

“…The rate of major complications was 3.1%, with a 1.3% rate of conversion to laparotomy. All the eight studies that evaluated the effect of surgery on symptoms (Abo et al, 2016;Brudie et al, 2012;Collinet et al, 2014;Ercoli et al, 2012;Morelli et al, 2016;Neme et al, 2013;Nezhat et al, 2011;Siesto et al, 2014), with a mean follow-up time of 15 months (range 2-28 months), reported either complete remission or a significant reduction of pain. The mean pregnancy rate among 73 women wishing to conceive in five studies was 38% at a mean follow-up of 16 months (range 10-24 months).…”

Place de la robotique dans l’endométriose pelvienne profonde : à propos du registre de la SERGS

“…Enfin, en 2011, Brudie et al ont publié une sé rie de 80 patientes opé ré es d'une endomé triose de stade IV par coelioscopie robotassisté e [27]. La duré e opé ratoire moyenne é tait plus courte que dans notre sé rie (115 minutes) mais les procé dures é taient moins complexes (77,6 % d'hysté rectomie, 36,3 % d'uré té rolyse, pas de shaving rectal, pas de ré section digestive, pas de cystectomie partielle, pas de ré implantation uré té ro-vé sicale) et il y a eu 5 % de laparoconversions (versus 0,6 % dans notre sé rie).…”