Roman Horace, Denost Quentin, Celhay Olivier, Merlot Benjamin
IFEMEndo, Clinique Tivoli-Ducos (Drs Roman and Merlot), Bordeaux, France; IFEMEndo Middle East Clinic, Burjeel Medical Center (Dr Roman), Abu Dhabi, UAE; Department of Gynecology and Obstetrics, Aarhus University Hospital (Dr Roman), Aarhus, Denmark.
Bordeaux Colorectal Institut, Clinique Tivoli-Ducos (Dr Denost), Bordeaux, France.
J Minim Invasive Gynecol. 2025 Jun 28. doi: 10.1016/j.jmig.2025.06.013.
To show that the laparoconversion in an emergency because of intraoperative complications does not require irreversibly abandoning the robotic procedure.
Tertiary referral center.
A young patient with deep endometriosis involving the lower rectum, both ureters with right hydronephrosis, the right sacral plexus, and the sciatic nerve, who underwent a previous excision attempt 4 years earlier.
The film summarizes a 10-hour complex surgical procedure of robotic excision of deep endometriosis. During the excision of the parametrial nodule [1], we injured a right sacral vein, leading to severe hemorrhage. Hemostasis attempts [2] were unsuccessful with the loss of 900 mL of blood during 10 minutes. The laparoconversion by median sub umbilical incision was carried out in an emergency and the hemorrhage was stopped by vein ligation. However, the dissection of the sacral plexus and sciatic nerve by open surgery appeared to be challenging because of the low visibility of anatomical structures behind the deep nodule of the parametrium. We decided to go back to gasless robotic surgery, thanks to the strengths of the 4 robotic arms, which could efficiently suspend the abdominal wall. The surgery ended by rectal resection with coloanal anastomosis [3] and reimplantation of the ureter. Nine months after the surgery, the patient is pain-free and completely satisfied by the outcomes, with complete bladder voiding, no deep dyspareunia, and satisfactory bowel movements.
The laparoconversion in an emergency, because of severe hemorrhage or other intraoperative complication, does not require irreversibly abandoning the robotic procedure, particularly in cases where the open approach does not offer comparable visibility, precision, or technical accuracy. Despite the opening of the abdomen and complete loss of the pneumoperitoneum, the robotic procedure may be successfully carried out in a gasless manner, thanks to the suspension of the abdominal wall by the strong robotic arms. VIDEO ABSTRACT.
证明因术中并发症而进行的急诊腹腔镜中转手术并不需要不可逆地放弃机器人手术。
三级转诊中心。
一名年轻患者，患有深部子宫内膜异位症，累及直肠下段、双侧输尿管（右侧肾积水）、右侧骶神经丛和坐骨神经，4年前曾尝试进行过一次切除手术。
该视频总结了一场长达10小时的机器人辅助深部子宫内膜异位症切除复杂手术过程。在切除子宫旁结节[1]时，我们损伤了一条右侧骶静脉，导致严重出血。止血尝试[2]未成功，在10分钟内失血900毫升。紧急情况下通过脐下正中切口进行了腹腔镜中转手术，并通过静脉结扎止住了出血。然而，由于子宫旁深部结节后方解剖结构的可视性较差，通过开放手术解剖骶神经丛和坐骨神经似乎具有挑战性。由于四个机器人手臂的优势，能够有效地悬吊腹壁，我们决定重新采用无气腹机器人手术。手术最终进行了直肠切除结肠肛管吻合术[3]并重新植入输尿管。术后九个月，患者无痛，对手术结果完全满意，膀胱排尿完全正常，无深部性交困难，排便情况良好。
因严重出血或其他术中并发症而进行的急诊腹腔镜中转手术，并不需要不可逆地放弃机器人手术，特别是在开放手术无法提供可比的可视性、精度或技术准确性的情况下。尽管打开了腹腔且气腹完全消失，但借助强大的机器人手臂悬吊腹壁，机器人手术仍可成功以无气腹方式进行。视频摘要。
