Robot-assisted total intracorporeal low anterior resection with primary anastomosis and radical dissection for treatment of stage IV endometriosis with bowel involvement: morbidity and its outcome

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Robot-assisted low anterior resection for stage IV endometriosis with bowel involvement was feasible and safe, showing similar operative times and blood loss but fewer complications compared to exploratory laparotomy.

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This study compared robot-assisted total intracorporeal low anterior resection with primary anastomosis and planned adjunct procedures (ureterolysis, hysterectomy, and bilateral salpingo-oophorectomy) versus exploratory laparotomy low anterior resection approaches in 18 women with stage IV endometriosis with bowel involvement. Using inclusion of patients undergoing RAL and ELLARH (8 and 10 cases, respectively), the authors reported similar operative times, blood loss, and hospital stay between approaches, with fewer complications observed in the robotic group (two complications) than in the laparotomy group (two blood transfusions and two rectovaginal fistulas), though differences were not statistically significant due to small sample size. They concluded the robotic procedure was feasible and safe for this setting. This paper is centrally about endometriosis — it evaluates morbidity and outcomes of robotic low anterior resection with primary anastomosis for stage IV bowel-involving endometriosis.

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Abstract

Robot-assisted low anterior resection with primary sigmoid rectal anastomosis/ureterolysis/hysterectomy with bilateral salpingo-oophorectomy (RALARH), and exploratory laparotomy low anterior resection with primary sigmoid rectal anastomosis/ureterolysis/hysterectomy with bilateral salpingo-oophorectomy (ELLARH). A total of eighteen patients (8 RALARH and 10 ELLARH) met the inclusion criteria. The mean age of the RALARH group was 47 and that of the ELLARH group was 36.9. There was no difference between body mass index (RALARH = 30.3 ± 6.6, 95% CI (25.7, 56.0) vs. ELLARH = 26.7 ± 7.5). Total operative time for the RALARH group was 238.5 ± 57.8 min, 95% CI: (164.5, 279.9) whereas that for the ELLARH group was 237 ± 117.7 min. There were no statistically significant differences between blood loss (RALARH = 425 ± 462.1 cc, 95% CI: (104.8, 745.2). ELLARH = 630 ± 432.2 cc) or days of hospitalization (RALARH = 5.5 ± 2.4 days, 95% CI: (3.8, 7.2) vs. ELLARH = 6.2 ± 1.6 days) in the RALARH and ELLARH groups. There were fewer complications in the RALARH group than in the ELLARH group (RALARH two complications vs. ELLARH two blood transfusion and two rectovaginal fistula), but the difference was not significant because of the small sample size. Robotic low anterior resection with primary sigmoid rectal anastomosis with ureterolysis at the time of hysterectomy and bilateral salpingo-oophorectomy for treatment of Stage IV endometriosis is a feasible and safe procedure.
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Abstract

Robot-assisted low anterior resection with primary sigmoid rectal anastomosis/ureterolysis/hysterectomy with bilateral salpingo-oophorectomy (RALARH), and exploratory laparotomy low anterior resection with primary sigmoid rectal anastomosis/ureterolysis/hysterectomy with bilateral salpingo-oophorectomy (ELLARH). A total of eighteen patients (8 RALARH and 10 ELLARH) met the inclusion criteria. The mean age of the RALARH group was 47 and that of the ELLARH group was 36.9. There was no difference between body mass index (RALARH = 30.3 ± 6.6, 95% CI (25.7, 56.0) vs. ELLARH = 26.7 ± 7.5). Total operative time for the RALARH group was 238.5 ± 57.8 min, 95% CI: (164.5, 279.9) whereas that for the ELLARH group was 237 ± 117.7 min. There were no statistically significant differences between blood loss (RALARH = 425 ± 462.1 cc, 95% CI: (104.8, 745.2). ELLARH = 630 ± 432.2 cc) or days of hospitalization (RALARH = 5.5 ± 2.4 days, 95% CI: (3.8, 7.2) vs. ELLARH = 6.2 ± 1.6 days) in the RALARH and ELLARH groups. There were fewer complications in the RALARH group than in the ELLARH group (RALARH two complications vs. ELLARH two blood transfusion and two rectovaginal fistula), but the difference was not significant because of the small sample size. Robotic low anterior resection with primary sigmoid rectal anastomosis with ureterolysis at the time of hysterectomy and bilateral salpingo-oophorectomy for treatment of Stage IV endometriosis is a feasible and safe procedure. Similar content being viewed by others

References

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