Robotic high intensity focused ultrasound treatment of rectal endometriosis

Rectal endometriosis is among the most symptomatic forms of the disease. When hormonal therapy fails, surgery is often required. High-intensity focused ultrasound (HIFU) is widely used in gynecology for the treatment of myomas and adenomyosis. Transrectal robotic HIFU has previously been used for the treatment of rectal endometriosis, and the clinical outcomes of this approach have been published. To our knowledge, this is the first publication of a dedicated video demonstrating this approach and detailing the technology, treatment planning and procedural steps.

The HIFU probe is inserted into the rectum under sonographic guidance. The rectal nodule is visualized and delineated by the physician using the imaging transducer. The software then divides the nodule into several slices. For each slice, the physician outlines the area to be treated. Based on the defined surface, the software calculates the number and location of HIFU shots needed to cover the entire lesion. Once all treatment zones are defined, the probe automatically positions itself at the lower edge of the lesion. The therapeutic transducer then delivers the HIFU energy, and the robotic system sequentially treats all predefined slices under real-time monitoring. Average procedure duration is 35 min, with treatment performed as an outpatient procedure.

Transrectal HIFU has undergone progressive clinical evaluation through prospective feasibility and multicentre safety studies, followed by comparative evaluation with conventional surgery. Published studies have reported a favorable safety profile, improvement in gynecological and digestive symptoms, and shorter hospitalization compared with surgery.

Transrectal robotic HIFU for rectal endometriosis appears to be a promising, minimally invasive alternative to surgery, with short treatment duration, low morbidity and significant symptom improvement.

Robotic transrectal high-intensity focused ultrasound offers a minimally invasive alternative to surgery for rectal endometriosis, with short procedure time, low morbidity and significant symptom improvement.