Neme Rosa Maria, Schraibman Vladimir, Okazaki Samuel, Maccapani Gabriel, Chen Winston Jenning, Domit Cassia Danielle, Kaufmann Oskar Grau, Advincula Arnold P
Hospital das Clinicas, Universidade de São Paulo, São Paulo, Brazil.
JSLS. 2013 Apr-Jun;17(2):227-34. doi: 10.4293/108680813X13693422521836.
Deep infiltrating pelvic endometriosis with bowel involvement is one of the most aggressive forms of endometriosis. Nowadays, robotic technology and telemanipulation systems represent the latest developments in minimally invasive surgery. The aim of this study is to present our preliminary results and evaluate the feasibility of robotic-assisted laparoscopic colorectal resection for severe endometriosis.
Between September 2009 and December 2011, 10 women with colorectal endometriosis underwent surgery with the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, CA, USA). We evaluated the following parameters: short-term complications, clinical outcomes and long-term follow-up, pain relief recurrence rate, and fertility outcomes.
Extensive ureterolysis was required in 8 women (80%). Ovarian cystectomy with removal of the cystic wall was performed in 7 women (70%). Torus resection was performed in all women, with unilateral and bilateral uterosacral ligament resection in 1 woman (10%) and 8 women (80%), respectively. In addition to segmental colorectal resection in all cases, partial vaginal resection was necessary in 2 women (20%). An appendectomy was performed in 2 patients (20%). The mean operative time with the robot was 157 minutes (range, 90-190 minutes). The mean hospital stay was 3 days. Six patients had infertility before surgery, with a mean infertility time of 2 years. After a 12-month follow-up period, 4 women (67%) conceived naturally and 2 (33%) underwent in vitro fertilization.
We show that robotic-assisted laparoscopic surgery for the treatment of deep infiltrating bowel endometriosis is feasible, effective, and safe.
累及肠道的深部浸润性盆腔子宫内膜异位症是子宫内膜异位症最具侵袭性的形式之一。如今，机器人技术和远程操作手术系统代表了微创手术的最新进展。本研究的目的是展示我们的初步结果，并评估机器人辅助腹腔镜结直肠切除术治疗重度子宫内膜异位症的可行性。
2009年9月至2011年12月期间，10例患有结直肠子宫内膜异位症的女性接受了达芬奇机器人手术系统（美国加利福尼亚州森尼韦尔市直观外科公司）手术。我们评估了以下参数：短期并发症、临床结果和长期随访、疼痛缓解复发率以及生育结果。
8名女性（80%）需要进行广泛的输尿管松解术。7名女性（70%）进行了卵巢囊肿切除术并切除囊壁。所有女性均进行了隆凸切除术，1名女性（10%）进行了单侧子宫骶韧带切除术，8名女性（80%）进行了双侧子宫骶韧带切除术。除所有病例均进行节段性结直肠切除外，2名女性（20%）还需要进行部分阴道切除。2例患者（20%）进行了阑尾切除术。使用机器人的平均手术时间为157分钟（范围90 - 190分钟）。平均住院时间为3天。6例患者术前不孕，平均不孕时间为2年。经过12个月的随访期，4名女性（67%）自然受孕，2名（33%）接受了体外受精。
我们表明，机器人辅助腹腔镜手术治疗深部浸润性肠道子宫内膜异位症是可行、有效且安全的。
