Araujo Sergio Eduardo Alonso, Seid Victor Edmond, Marques Renato Moretti, Gomes Mariano Tamura Vieira
Hospital Israelita Albert Einstein, 627, Albert Einstein Ave, suite 219, Sao Paulo, SP, 05652-901, Brazil.
J Robot Surg. 2016 Jun;10(2):165-9. doi: 10.1007/s11701-016-0586-8. Epub 2016 Apr 12.
For symptomatic deep infiltrating endometriosis, surgery is often required to achieve symptom relief and restore fertility. A minimally invasive approach using laparoscopy is considered the gold standard. However, specific limitations of the laparoscopic approach deep in the pelvis keep challenging even surgeons with a solid experience with minimally invasive techniques. Robotic surgery has the potential to compensate for technical drawbacks inherent in conventional laparoscopic surgery, such as limited degree of freedom, two-dimensional vision, and the fulcrum effect. In the present report, we aim at demonstrating the central role of robotic surgery for deep infiltrating endometriosis, with special emphasis in the ability to practice organ (rectal) preservation. A 45-year-old white female with a 4-month history of chronic pelvic pain, dyschezia, and dysmenorrhea, refractory to hormonal therapy was referred to our unit. MRI findings were diagnostic of deep infiltrating endometriosis (retrocervical and rectovaginal) extending to the anterior rectal serosal layer (partial-thickness rectal invasion). Using a fully robotic approach, appropriate dissection of the rectovaginal septum and of the extraperitoneal rectum followed by complete excision of the endometriotic rectal nodule with organ (rectal) preservation was undertaken. It is our belief that using a robotic approach, the potential to boost rectal preservation might be established. Moreover, it is possible that in many cases, a robotic operation may allow the surgeon to perform the intervention with greater accuracy and comfort. As a result, more patients with deep infiltrating endometriosis may benefit from rectal sparing procedures.
对于有症状的深部浸润性子宫内膜异位症，通常需要手术来缓解症状并恢复生育能力。使用腹腔镜的微创方法被认为是金标准。然而，盆腔深部腹腔镜手术方法的特定局限性即使对于有丰富微创技术经验的外科医生来说也一直是挑战。机器人手术有可能弥补传统腹腔镜手术固有的技术缺陷，如自由度有限、二维视野和支点效应。在本报告中，我们旨在证明机器人手术在深部浸润性子宫内膜异位症中的核心作用，特别强调保留器官（直肠）的能力。一名45岁的白人女性，有4个月慢性盆腔疼痛、排便困难和痛经病史，激素治疗无效，被转诊至我院。MRI检查结果诊断为深部浸润性子宫内膜异位症（宫颈后和直肠阴道），延伸至直肠前浆膜层（直肠部分厚度浸润）。采用全机器人手术方法，对直肠阴道隔和腹膜外直肠进行适当解剖，然后完整切除子宫内膜异位直肠结节并保留器官（直肠）。我们相信，采用机器人手术方法，可能确立提高直肠保留率的可能性。此外，在许多情况下，机器人手术可能使外科医生能够更精确、更舒适地进行干预。因此，更多深部浸润性子宫内膜异位症患者可能从保留直肠的手术中受益。
