Robotic multidisciplinary endometriosis surgery with multi-visceral resection: evaluation of short-term feasibility...

Despite growing interest in robot-assisted surgery, the literature remains limited on the application of robotic surgery for complex endometriosis surgery requiring multidisciplinary input for multi-visceral resection. The aim of the study was to report the short-term feasibility and safety outcomes of this technique from a high-volume robotic surgery facility.

This was a single centre, retrospective study evaluating prospectively collected data. All women underwent planned multidisciplinary robotic surgery using the da Vinci Xi system between January 2018 and July 2024. Fifty-eight patients were included in the analysis of demographic, operative and 30-day postoperative data.

The median age was 40.5 (range 21-55), with 94.82% of women having ASRM grade 3-4 endometriosis. Almost half of the patients had total hysterectomy and bilateral salpingectomy. Concurrent colorectal resections included appendicectomy/stapled caecectomy (41.38%), rectal shaving (36.21%), rectal wedge resection (39.66%), endo-anal discoid resection (1.72%) and rectal segmental resection (15.52%). Partial bladder excision and extensive ureterolysis for ureteral stenosis occurred in 5.17% and 11.54%, respectively. The median console time was 148 min (range 49-480 min), 0% conversions and a median 100mls estimated blood loss. Median length of stay was 3 days (range 1-7). Clavien-Dindo complications ≥2 occurred 5.17% of cases. There were no anastomotic leaks, other infectious complications, postoperative ileus, blood transfusion requirements or mortality within 30 days.

The robotic assisted approach is feasible and safe with overall short operative time, acceptable blood loss, no conversions, relatively short length of stay and minimal short term postoperative complications.