Segmental Bowel Resection for Rectal Endometriosis Using the da Vinci SP

Area of Science:

• Minimally Invasive Surgery
• Gynecologic Oncology
• Robotic Surgery

Background:

• Rectal endometriosis can cause chronic pelvic pain and necessitate surgical intervention.
• Single-port (SP) robotic surgery offers potential advantages in cosmesis and patient recovery.
• The da Vinci SP Surgical System received regulatory approval for gynecological surgeries in Japan in 2023.

Purpose of the Study:

• To report the first known use of the da Vinci SP Surgical System for treating rectal endometriosis with segmental bowel resection.
• To evaluate the safety, feasibility, and outcomes of this novel surgical approach.

Main Methods:

• A 46-year-old woman with symptomatic rectal endometriosis underwent robotic surgery using the da Vinci SP system.
• A single umbilical access port facilitated the insertion of articulating instruments and a camera.
• Surgical steps mirrored conventional multiport robotic surgery, with an assistant port for stapler use.

Main Results:

• The procedure involved a 30-mm vertical umbilical incision and segmental bowel resection.
• Total operative time was 216 minutes with an estimated blood loss of 100 ml.
• The patient experienced an uneventful postoperative course with no complications, including no bladder dysfunction or low anterior resection syndrome.

Conclusions:

• Single-port robotic surgery using the da Vinci SP system is technically safe and feasible for segmental bowel resection in rectal endometriosis.
• This approach offers benefits of good cosmesis and reduced pain.
• Surgical skills for conventional laparoscopic or robotic surgery are transferable to the SP system.