Robotic Surgery a Step Forward in Standardization of Hysterectomy in Patients with Deep Infiltrating Endometriosis

Elvira Bratilă, Bratilă E, Elvira Brătilă, Diana Comandaşu, Comandaşu D, C.B. Coroleucă, Cătălin Bogdan Coroleucă, Cătălin Coroleucă, Andrei Manu, Manu A, Petre Brătilă, Petre Bratila, Brătilă P
Chirurgia (Bucharest, Romania : 1990) · 2023 · vol. 118(1) , pp. 73 · doi:10.21614/chirurgia.2825 · PMID:36913420 · W4324018718
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This paper describes a standardized robotic hysterectomy approach using virtual compartments for patients with deep infiltrating endometriosis, finding it reduces blood loss, operative time, and complications.

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Abstract

UNLABELLED: Introduction: Hysterectomy in cases with deep infiltrating endometriosis (DIE) poses a particular challenge represented by the lack of standardization, causing technical difficulties or incomplete resection of the deep endometriosis lesions. AIM: This article attempts to use the concept of lateral and antero-posterior virtual compartments in the standardization of robotic hysterectomy (RH) in cases of deep parametrial lesions according to ENZIAN classification. MATERIAL AND METHOD: We collected data from 81 patients who underwent total hysterectomy and en bloc excision of the endometriotic lesions by robotic surgery. Results: Excision was realized by the technique of retroperitoneal hysterectomy, its standardization depending on the ENZIAN classification being described step by step. Tailored robotic hysterectomy always included the en-block removal of uterus, adnexa, and posterior and anterior parametria, which included endometriotic lesions and the upper one-third of the vagina with all endometriotic lesions of posterior and lateral vaginal mucosa. Discussion: The hysterectomy and parametrial dissection must be done according to the size and location of the endometriotic nodule. The goal of hysterectomy for DIE is to release the uterus and the endometriotic tissue without risks of complication. CONCLUSION: "En-bloc" hysterectomy together with endometriotic nodules, where the parametrial resection is tailored according to the lesions, is an optimum method, because the blood loss, operative time, and intraoperative complications are reduced comparing with other methods.

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Outcome instruments

Enzian

Condition tags

endometriosisdie_deep_infiltrating

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (24)

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