Can the robot help heal endometriosis?

Researchers at the Charles Nicolle University Hospital, Rouen, France, recently set out to assess the effectiveness of robot-assisted surgery in patients with deep infiltrating endometriosis (DIE); ie, invasive endometriosis that may affect the uterosacral ligaments, rectum, rectovaginal septum, vagina, and bladder.

The study involved 35 patients treated for DIE using robotic assistance in the hospital between September 2011 and March 2014. The patients completed questionnaires including questions on pain and digestive symptoms preoperatively and 1 year after surgery.

The 35 patients represented 54% of patients managed for gynecological disease by the laparoscopic route with robotic assistance during the study period, and 14% of patients managed for deep endometriosis in the researchers’ department. Follow-up averaged 24 ±8 months, and no patient was lost to follow-up. Thirty-two patients had rectal involvement: rectal shaving was performed in 25 patients, disc excision in 3, and colorectal resection in 4. Three patients had bladder resection. Thirteen patients presented with deep endometriosis of the ureters: ureterolysis was performed in 11 of them, and resection of the ureter followed by reimplantation into the bladder in 2 patients.

The researchers noted that one major complication occurred: a patient presenting with necrosis of the right ureter on postoperative day 5. Nine patients attempted to conceive after surgery and 8 had become pregnant at the time the study was published (88.9%). One year after surgery, patient questionnaires revealed a significant decrease in pain symptoms and significant improvement in several gastrointestinal measures.

The researchers concluded that surgical management of DIE is feasible using robotic assistance. However, they noted that the data available in the literature and their experience together do not definitively support the hypothesis of the superiority of robotic assistance in the management of DIE.

Abo C, Roman H, Bridoux V, et al. Management of deep infiltrating endometriosis by laparoscopic route with robotic assistance: 3-year experience. J Gynecol Obstet Hum Reprod. 2017;46(1):9-18.