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

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.