Robot-assisted laparoscopy for deep infiltrating endometriosis of bowel

Robotic surgery provides superior maneuverability to surgeons during surgery.

Key Points

Importance:

• Robot-assisted laparoscopic surgery has proven to be a viable alternative to traditional laparoscopy. The literature offers limited evidence supporting the advantages of robot-assisted surgery over standard laparoscopy for treating symptomatic bowel deep infiltrating endometriosis.

Highlights:

• The feasibility of robotic surgery is an alternative to standard laparoscopic surgery for the treatment of rectosigmoid endometriosis.

What's done here:

• An Australian author team conducted a systematic review to identify robotic-assisted laparoscopic surgery for bowel-deep infiltrated endometriosis.

Key Results:

• Eleven primary studies were evaluated from which surgical details and operative and postoperative outcomes were collected.
• In these studies, 83  patients had standard laparoscopic surgery, and 364 underwent robotic-assisted laparoscopic surgery.
• The comparison of those two types of surgery indicated longer mean operating time but shorter hospital stays and fewer postoperative complications in the robotic surgery group.
• Major and minor complications occurred in 4.4% and 6.4% of the robotic group, compared to 3.6% and 22.9% in the laparoscopic group. Anastomotic leak was 0,6% in the robotic group.
• Four studies reported significant improvements in pain symptoms within the robotic-assisted laparoscopic surgery at least 6 months after the surgery.

Lay Summary

Ong et al., from the University of Melbourne, Australia, conducted a literature review to assess the surgical procedure details, operative parameters, and postoperative outcomes of robot-assisted laparoscopic surgery, although the literature remains limited. They compared this method to standard laparoscopic surgery to provide insights into the feasibility of this surgical approach. Nine of eleven literature studies that met the criteria were non-comparative robot-assisted laparoscopic surgery cohort studies. Among the patients who underwent robot-assisted laparoscopic surgery and standard laparoscopic surgery for rectosigmoid endometriosis in those 11 studies, 59% and 35% had rectal shaves, 8% and 19% had discoid excision, and 33% and 49% had segmental resections.

The robotic group's prevalence of rectal shaving is higher, depending on the technique's benefits. The technique offers better vision to the surgeon, enabling complete excision with clear margins. However, if more extensive resection is needed, the complexity could diminish its advantages. 

The authors discussed the high start-up costs and duration of robotic surgery. They concluded that future research is essential to provide additional perspective on the medico-economic implications associated with robotic-assisted laparoscopic surgery. This review was recently published in the International Journal of Colorectal Disease.

Research Source: https://pubmed.ncbi.nlm.nih.gov/38922440/