Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK.
The Princess Grace Hospital Robotic Endometriosis Centre, The Harley Street Clinic, HCA Healthcare UK, London, UK.
Tech Coloproctol. 2024 Feb 8;28(1):31. doi: 10.1007/s10151-023-02904-0.
Bowel endometriosis impacts quality of life. Treatment requires complex surgical procedures with associated morbidity. Precision approach with robotic surgery leads to organ preservation. Bowel endometriosis requires a multidisciplinary management to improve patient outcomes. This study evaluates perioperative outcomes of bowel endometriosis undergoing multidisciplinary planning and robotic surgery.
Consecutive cases of multidisciplinary robotic bowel endometriosis procedures (January 2021-December 2022) were evaluated from a prospectively maintained database in a national endometriosis accredited centre. Patients were managed through a multidisciplinary setting including gynaecologists, colorectal robotic surgeons, and other specialists. Dyschezia (menstrual and non-cyclical) and quality of life were assessed pre- and postoperatively (6 months) through validated questionnaires.
Sixty-eight consecutive cases of robotic bowel endometriosis were included. Median age was 35.0 (30.2-42.0) years. Median body mass index was 24.0 (21.0-26.7) kg/m. Procedures performed were 48 (70.6%) shavings, 11 (16.2%) deep shavings, 3 (4.4%) disc excisions, and 6 (8.8%) segmental resections. One (1.5%) patient required temporary stoma. Median operating time was 150 (120-180) min. There were no conversions/return to theatre postoperatively. Median endometriotic nodule size was 25.0 (15.5-40.0) mm. Two (2.9%) patients developed postoperative complications. Median length of postoperative stay was 2 (2-4) days. Median follow-up was 12 (7-17) months. One (1.5%) patient recurred. Median menstrual dyschezia score improved from 5.0 (2.0-8.0) to 1.0 (0.0-5.7). Median non-cyclical dyschezia significantly improved (p < 0.001) from 1.0 (0.0-5.7) to 0.0 (0.0-2.0). Median quality of life score improved from 52.5 (35.0-70.0) to 74.5 (60.0-80.0).
Robotic multidisciplinary approach to bowel endometriosis provides good perioperative outcomes with improvement of dyschezia and quality of life.
肠子宫内膜异位症影响生活质量。治疗需要复杂的手术，伴有相关发病率。机器人手术的精准方法可实现器官保留。肠子宫内膜异位症需要多学科管理以改善患者结局。本研究评估了接受多学科规划和机器人手术的肠子宫内膜异位症患者的围手术期结局。
从全国子宫内膜异位症认证中心的前瞻性维护数据库中评估了 2021 年 1 月至 2022 年 12 月连续进行的多学科机器人肠子宫内膜异位症手术病例。患者通过妇科医生、直肠机器人外科医生和其他专家组成的多学科团队进行管理。通过经过验证的问卷在术前（6 个月）和术后评估排便困难（月经和非周期性）和生活质量。
纳入了 68 例连续的机器人肠子宫内膜异位症病例。中位年龄为 35.0（30.2-42.0）岁。中位体重指数为 24.0（21.0-26.7）kg/m。手术方式为 48 例（70.6%）刮除术、11 例（16.2%）深部刮除术、3 例（4.4%）椎间盘切除术和 6 例（8.8%）节段切除术。1 例（1.5%）患者需要临时造口术。中位手术时间为 150（120-180）min。无术后中转/再次手术。中位子宫内膜异位症结节大小为 25.0（15.5-40.0）mm。2 例（2.9%）患者术后发生并发症。中位术后住院时间为 2（2-4）天。中位随访时间为 12（7-17）个月。1 例（1.5%）患者复发。中位月经性排便困难评分从 5.0（2.0-8.0）改善至 1.0（0.0-5.7）。非周期性排便困难显著改善（p<0.001），从 1.0（0.0-5.7）改善至 0.0（0.0-2.0）。中位生活质量评分从 52.5（35.0-70.0）改善至 74.5（60.0-80.0）。
机器人多学科方法治疗肠子宫内膜异位症可获得良好的围手术期结局，并改善排便困难和生活质量。
