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

Abstract

Objective This 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. Methods One 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. Results The 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. Conclusions This study suggests that robotic-assisted laparoscopy is a feasible method to resect deep infiltrating endometriosis, especially in the rectosigmoid area.

Endometriosis: Epidemiology, Classification, Pathogenesis, Treatment and Genetics (Review of Literature)

“…The latest study suggests that robot-assisted laparoscopy is a possible method of DIE resection [ 134 ].…”

Efficacy between Conventional Laparoscopy and Robotic Surgery in Mexican Patients with Endometriosis: A Comparative Study

“…RAL employs 3D technology, facilitating better visualization of the surgical site and instrumentation with seven degrees of freedom, providing reduced manipulation of tremors, and reducing work fatigue. Likewise, it shortens the learning curve compared with laparoscopic surgery [ 17 , 23 , 24 ]. Results in the intraoperative and postoperative outcomes between RAL and CL are contradictory and questionable in relation to the concept of cost–benefit [ 25 ]; however, it has been shown that although RAL implies a 20% higher cost compared with CL, the benefit is greater in cases of deep endometriosis, especially in implants in the colon and rectum [ 20 ].…”

“…In our study, we evaluated patients with ENZIAN classification grades 1 to 3, which indicates deep endometriosis, unlike many reports carried out in the United States and European countries that used the American Society for Reproductive Medicine classification (rASRM score) [ 24 , 26 , 27 , 28 ]. In this sense, Keckstein and Hudelist proposed that the rASRM score has greater clinical acceptance and is more useful in cases of infertility secondary to endometriosis, while the ENZIAN classification has greater usefulness in deep endometriosis and a greater relationship with complication rates [ 8 ].…”

Robot-assisted laparoscopy does not have demonstrable advantages over conventional laparoscopy in endometriosis surgery: a systematic review and meta-analysis

“…In some articles, more radical procedures (e.g., endometriosis surgery with concomitant hysterectomy) were performed and patients with more advanced endometriosis were operated on with RAL according to the revised American Society for Reproductive Medicine (rASRM) staging. This might indicate that the surgeon favored a robotic approach and might have added bias to the results, contributing to differences in operating times [ 24 , 31 ]. However, we did not find significant differences in rASM classification between the two approaches.…”