{"paper_id":"1f221864-8dbb-41f3-8559-ae7fc39aee6e","body_text":"Abstract\nObjective\nThis study aimed at assessing perioperative results of robot-assisted laparoscopy (RAL) in the context of deep infiltrating endometriosis (DIE).\nMethods\nThis retrospective French multicentric study included all patients with DIE who underwent surgical treatment managed by RAL (Da Vinci® System). From November 2008 to June 2019, patients were included in a single European database, in Robotic Assisted Laparoscopic Gynecologic Surgery, with Society of European Robotic Gynecological Surgery collaboration. Patients had different DIE sites as follows: gynecological, urological, or digestive, or combinations of these. Surgical procedures and perioperative complications were evaluated. To assess complications, patients were divided into the following four groups according to surgical procedure and DIE site: gynecological only; gynecological and urological; gynecological and digestive; and gynecological, urological, and digestive.\nResults\nA total of 460 patients treated at one of eight health-care facilities from November 2008 to June 2019 were included. Median operative time was 245 min (IQR 186–320), surgeon console time was 138 ± 75 min and estimated blood loss was 70.0 mL ± 107 mL. Among this patient sample, 42.1% had a multidisciplinary surgical approach with a digestive or urology surgeon in addition to gynecology surgeon (25.5% and 16.6% of cases, respectively). Among those with intraoperative complications (n = 25, 5.4%) were primarily conversion to laparotomy (n = 6, 2.0%), transfusion (n = 2, 0.6%), and organ wounds (n = 8, 1.7%). Overall, 5.6% had severe postoperative complications (Clavien–Dindo classification ≥ Grade 3).\nConclusion\nThis is among the largest published series addressing RAL for DIE. Interest in this procedure appears promising, with no observed increases in blood loss or in peri- or post-operative complications. DIE laparoscopic surgery can require complex surgical procedures performed by multidisciplinary surgical teams. Thus, it may be one of the best candidates for RAL within gynecology surgery.\nSimilar content being viewed by others\nReferences\nGuo S-W, Wang Y (2006) The prevalence of endometriosis in women with chronic pelvic pain. Gynecol Obstet Invest 62(3):121–130\nBorghese B, Santulli P, Marcellin L, Chapron C (2018) Définition, description, formes anatomo-cliniques, pathogenèse et histoire naturelle de l’endométriose, RPC Endométriose CNGOF-HAS. Gynécologie Obstétrique Fertil Sénologie 46(3):156–167\nVercellini P, Viganò P, Somigliana E, Fedele L (2014) Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol 10(5):261–275\nSimoens S, Dunselman G, Dirksen C, Hummelshoj L, Bokor A, Brandes I et al (2012) The burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centres. Hum Reprod Oxf Engl 27(5):1292–1299\nSoliman AM, Yang H, Du EX, Kelley C, Winkel C (2016) The direct and indirect costs associated with endometriosis: a systematic literature review. Hum Reprod Oxf Engl 31(4):712–722\nKoninckx PR, Meuleman C, Demeyere S, Lesaffre E, Cornillie FJ (1991) Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain. Fertil Steril 55(4):759–765\nRoman H, Ballester M, Loriau J, Canis M, Bolze PA, Niro J et al (2018) Synthèse des stratégies et prise en charge chirurgicale de l’endométriose, RPC Endométriose CNGOF-HAS. Gynécologie Obstétrique Fertil Sénologie 46(3):326–330\nChapron C, Bourret A, Chopin N, Dousset B, Leconte M, Amsellem-Ouazana D et al (2010) Surgery for bladder endometriosis: long-term results and concomitant management of associated posterior deep lesions. Hum Reprod Oxf Engl 25(4):884–889\nChapron C, Chopin N, Borghese B, Foulot H, Dousset B, Vacher-Lavenu MC et al (2006) Deeply infiltrating endometriosis: pathogenetic implications of the anatomical distribution. Hum Reprod Oxf Engl 21(7):1839–1845\nChapron C, Fauconnier A, Vieira M, Barakat H, Dousset B, Pansini V et al (2003) Anatomical distribution of deeply infiltrating endometriosis: surgical implications and proposition for a classification. Hum Reprod Oxf Engl 18(1):157–161\nChapron C, Chiodo I, Leconte M, Amsellem-Ouazana D, Chopin N, Borghese B et al (2010) Severe ureteral endometriosis: the intrinsic type is not so rare after complete surgical exeresis of deep endometriotic lesions. Fertil Steril 93(7):2115–2120\nSeracchioli R, Manuzzi L, Mabrouk M, Solfrini S, Frascà C, Manferrari F et al (2010) A multidisciplinary, minimally invasive approach for complicated deep infiltrating endometriosis. Fertil Steril 93(3):1007.e1-1007.e3\nNezhat C, Lewis M, Kotikela S, Veeraswamy A, Saadat L, Hajhosseini B et al (2010) Robotic versus standard laparoscopy for the treatment of endometriosis. Fertil Steril 94(7):2758–2760\nFalcone T, Goldberg JM (2003) Robotics in gynecology. Surg Clin North Am 83(6):1483–1489\nNezhat C, Saberi NS, Shahmohamady B, Nezhat F (2006) Robotic-assisted laparoscopy in gynecological surgery. JSLS 10(3):317–320\nNezhat FR, Sirota I (2014) Perioperative outcomes of robotic assisted laparoscopic surgery versus conventional laparoscopy surgery for advanced-stage endometriosis. JSLS 18(4):e2014.00094\nSussfeld J, Segaert A, Rubod C, Collinet P (2016) Role of robotic surgery in the management of deep infiltrating endometriosis. Minerva Ginecol 68(1):49–54\nRoman H (2017) A national snapshot of the surgical management of deep infiltrating endometriosis of the rectum and colon in France in 2015: a multicenter series of 1135 cases. J Gynecol Obstet Hum Reprod 46(2):159–165\nBot-Robin V, Rubod C, Zini L, Collinet P (2011) Étude de faisabilité du traitement laparoscopique robot-assisté de lésions d’endométriose pelvienne profonde. Gynécologie Obstétrique Fertil. 39(7):407–411\nDiguisto C, Hébert T, Paternotte J, Kellal I, Marret H, Ouldamer L et al (2015) Robotic assisted laparoscopy: comparison of segmentary colorectal resection and shaving for colorectal endometriosis. Gynecol Obstet Fertil 43(4):266–270\nle Carpentier M, Merlot B, Bot Robin V, Rubod C, Collinet P (2016) Étude comparative: laparoscopie robot assistée versus cœlioscopie chez les patientes avec une endométriose vésicale. Gynécologie Obstétrique Fertil 44(6):315–321\nMuhlstein J, Monceau E, Lamy C, Tran N, Marchal F, Judlin P et al (2012) Contribution of robot-assisted surgery in the management of female infertility. J Gynecol Obstet Biol Reprod (Paris) 41(5):409–417\nMonsarrat N, Collinet P, Narducci F, Leblanc E, Vinatier D (2009) Assistance robotisée en chirurgie gynécologique: état des lieux. Gynécologie Obstétrique Fertil 37(5):415–424\nBallester M, Roman H (2018) Surgical management of deep endometriosis with colorectal involvement: CNGOF-HAS Endometriosis Guidelines. Gynecol Obstet Fertil Senol 46(3):290–295\nRoman H, Chanavaz-Lacheray I, Forestier D, Magne E, Celhay O, Pasticier G et al (2020) Complications postopératoires immédiates dans un centre chirurgical multidisciplinaire exclusivement dédié à l’endométriose: une série de 491 patientes. Gynécologie Obstétrique Fertil Sénologie 48(6):484–490\nJackson T, Cho EE, Nagatomo K, Osman HG, Jeyarajah DR (2020) Teacher and trainee learning together—dual console and the 3 arms. J Surg Educ 77(4):720–722\nMargueritte F, Sallée C, Legros M, Lacorre A, Piver P, Aubard Y et al (2020) Description of an initiation program to robotic in vivo gynecological surgery for junior surgeons. J Gynecol Obstet Hum Reprod 49(3):101627\nBolger JC, Broe MP, Zarog MA, Looney A, McKevitt K, Walsh D et al (2017) Initial experience with a dual-console robotic-assisted platform for training in colorectal surgery. Tech Coloproctol 21(9):721–727\nPanel P, Chis C, Gaudin S, Letohic A, Raynal P, Mikhayelyan M et al (2006) Traitement cœlioscopique de l’endométriose profonde. À propos de 118 cas. Gynécologie Obstétrique Fertil 34(7):583–592\nBendifallah S, Ballester M, Darai E (2017) Prise en charge chirurgicale des lésions d’endométriose profondes avec atteinte digestive et urinaire. Presse Med 46(12, Part 1):1212–1217\nSoto E, Luu TH, Liu X, Magrina JF, Wasson MN, Einarsson JI et al (2017) Laparoscopy vs Robotic Surgery for Endometriosis (LAROSE): a multicenter, randomized, controlled trial. Fertil Steril 107(4):996–1002 (e3)\nLe Gac M, Ferrier C, Touboul C, Owen C, Arfi A, Boudy A-S et al (2020) Comparison of robotic versus conventional laparoscopy for the treatment of colorectal endometriosis: pilot study of an expert center. J Gynecol Obstet Hum Reprod 49:101885\nAcknowledgements\nThe authors thank the Data Management and Analysis Centre (DMAC) at the Paoli Calmettes Institute (IPC) in Marseille (France) and the Society of European Robotic Gynecological Surgery (SERGS) for accessing and using data from the European Robotic Datase (EUROD).\nAuthor information\nAuthors and Affiliations\nContributions\nTG and PC: investigators of the project ES and CP: data collection ES, CP, EB, LG: had participated in preparing the bibliography. JB, EB, FG, TH, YK, VL, BM, SM, CT, FV, TG, PC: the surgeons who participated in surgeries.\nCorresponding author\nEthics declarations\nConflict of interest\nThe authors have no conflict of interest.\nAdditional information\nPublisher's Note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nRights and permissions\nAbout this article\nCite this article\nSaget, E., Peschot, C., Bonin, L. et al. Robot-assisted laparoscopy for deep infiltrating endometriosis: a retrospective French multicentric study (2008–2019) using the Society of European Robotic Gynecological Surgery endometriosis database. Arch Gynecol Obstet 305, 1105–1113 (2022). https://doi.org/10.1007/s00404-022-06414-6\nReceived:\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s00404-022-06414-6","source_license":"public-domain-us","license_restricted":false}