S Hanssens1, M Nisolle2, P Leguevaque3, R M Neme4, V Cela5, P Barton-Smith6, T Hébert7, P Collinet8. 1. Maternité et hôpital Jeanne-de-Flandre, centre hospitalier régional universitaire de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France. Electronic address: sandyhg@free.fr. 2. Service de gynécologie-obstétrique, université de Liège, CHR de la Citadelle, 1, boulevard du 12(e)-de-Ligne, 4000 Liège, Belgique. 3. Service de gynécologie, hôpital Rangueil, 1, avenue J.-Pouilhès, 31059 Toulouse cedex 09, France. 4. Centro d'endometriose São Paulo, avenida República do Líbano, 460, São Paulo, Brazil. 5. Department of reproductive medicine and child development, division of obstetrics and gynecology, university of Pisa, via Roma 67, 56126 Pisa, Italie. 6. Department of gynaecological oncology, St. George's Hospital, Blackshaw road, London SW17 0QT, Royaume-Uni. 7. Service de gynécologie, CHU Bretonneau, 37044 Tours cedex 01, France. 8. Maternité et hôpital Jeanne-de-Flandre, centre hospitalier régional universitaire de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France.
Abstract
OBJECTIVES: To assess the interest of robotic-assisted laparoscopy in the context of deep infiltrating endometriosis and to investigate perioperative results. PATIENTS AND METHODS: From November 2008 to April 2012, 164 women with stage IV endometriosis who underwent robotic-assisted laparoscopy (DA VINCI Intuitive Surgical System(®)) were included by eight international participating clinical centers. Patients were divided in 4 groups according to the localization of the nodule(s): rectum (n=88), bladder (n=23), ureter and uterosacral ligaments (n=115) et hysterectomy (n=28). We evaluated the procedures performed, the duration of intervention, the complications, the recurrence and the impact on fertility. RESULTS: In the rectum group, there was a laparotomy conversion, 2 sutured rectal injuries and a red cells blood transfusion. In the bladder group, there was a vesicovaginal hematoma and a prolongated intermittent self-catheterization. In the ureter and uterosacral ligaments group, there was 2 ureteral fistulas and there was no complication in the hysterectomy group. DISCUSSION AND CONCLUSION: This study is the largest series published in the literature on robotic-assisted laparoscopy for deep infiltrating endometriosis. The interest of robotic-assisted laparoscopy in deep infiltrating endometriosis seems to be promising while no increase in surgical time, blood loss, and intra- and postoperative complications were observed.
OBJECTIVES: To assess the interest of robotic-assisted laparoscopy in the context of deep infiltrating endometriosis and to investigate perioperative results. PATIENTS AND METHODS: From November 2008 to April 2012, 164 women with stage IV endometriosis who underwent robotic-assisted laparoscopy (DA VINCI Intuitive Surgical System(®)) were included by eight international participating clinical centers. Patients were divided in 4 groups according to the localization of the nodule(s): rectum (n=88), bladder (n=23), ureter and uterosacral ligaments (n=115) et hysterectomy (n=28). We evaluated the procedures performed, the duration of intervention, the complications, the recurrence and the impact on fertility. RESULTS: In the rectum group, there was a laparotomy conversion, 2 sutured rectal injuries and a red cells blood transfusion. In the bladder group, there was a vesicovaginal hematoma and a prolongated intermittent self-catheterization. In the ureter and uterosacral ligaments group, there was 2 ureteral fistulas and there was no complication in the hysterectomy group. DISCUSSION AND CONCLUSION: This study is the largest series published in the literature on robotic-assisted laparoscopy for deep infiltrating endometriosis. The interest of robotic-assisted laparoscopy in deep infiltrating endometriosis seems to be promising while no increase in surgical time, blood loss, and intra- and postoperative complications were observed.
Keywords:
Cœlioscopie robot-assistée; Da Vinci(®) system; Deep infiltrating endometriosis; Endométriose pelvienne profonde; Robotic-assisted laparoscopy; Système Da Vinci(®)