Robot-assisted surgery for the radical treatment of deep infiltrating endometriosis with colorectal involvement: short- and mid-term surgical and functional outcomes

Purpose Sexual and urinary dysfunctions are complications in radical treatment of deep infiltrating endometriosis (DIE) with colorectal involvement. The aim of this article is to report the preliminary results of our single-institution experience with robotic treatment of DIE, evaluating intraoperative and postoperative surgical outcomes and focusing on the impact of this surgical approach on autonomic functions such as urogenital preservation and sexual well-being.

From January 2011 through December 2013, a case series of 10 patients underwent robotic radical treatment of DIE with colorectal resection using the da Vinci System. Surgical data were evaluated, together with perioperative urinary and sexual function as assessed by means of self-administered validated questionnaires.

None of the patients reported significant postoperative complications. Questionnaires concerning sexual well-being, urinary function, and impact of symptoms on quality of life demonstrated a slight worsening of all parameters 1 month after surgery, while data were comparable to the preoperative period 1 year after surgery. Dyspareunia was the only exception, as it was significantly improved 12 months after surgery.

Robot-assisted surgery seems to be advantageous in highly complicated procedures where extensive dissection and proper anatomy re-establishment is required, as in DIE with colorectal involvement. Our preliminary results show that robot-assisted surgery could be associated with a low risk of complications and provide good preservation of urinary function and sexual well-being. Similar content being viewed by others

Kennedy S, Bergqvist A, Chapron C, D’Hooghe T, Dunselman G, Greb R, Hummelshoj L, Prentice A, Saridogan E, E.S.I.G.f. Endometriosis, and G. Endometrium Guideline Development (2005) ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 20(10):2698–2704 Giudice LC, S.L., Burney RO, Endometriosis. In: Jameson Jl, De Groot LJ, eds. 6th ed, ed. Endocrinology. 2010, New York: Elsevier. Ballweg ML (2004) Impact of endometriosis on women’s health: comparative historical data show that the earlier the onset, the more severe the disease. Best Pract Res Clin Obstet Gynaecol 18(2):201–218 Garry R, Clayton R, Hawe J (2000) The effect of endometriosis and its radical laparoscopic excision on quality of life indicators. Bjog 107(1):44–54 Redwine DB, Wright JT (2001) Laparoscopic treatment of complete obliteration of the cul-de-sac associated with endometriosis: long-term follow-up of en bloc resection. Fertil Steril 76(2):358–365 Neme RM, Schraibman V, Okazaki S, Maccapani G, Chen WJ, Domit CD, Kaufmann OG, Advincula AP (2013) Deep infiltrating colorectal endometriosis treated with robotic-assisted rectosigmoidectomy. Jsls 17(2):227–234 Vitobello D, Fattizzi N, Santoro G, Rosati R, Baldazzi G, Bulletti C, Palmara V (2013) Robotic surgery and standard laparoscopy: a surgical hybrid technique for use in colorectal endometriosis. J Obstet Gynaecol Res 39(1):217–222 Siesto G, Ieda N, Rosati R, Vitobello D (2014) Robotic surgery for deep endometriosis: a paradigm shift. Int J Med Robot 10(2):140–146 Bianchi PP, Rosati R, Bona S, Rottoli M, Elmore U, Ceriani C, Malesci A, Montorsi M (2007) Laparoscopic surgery in rectal cancer: a prospective analysis of patient survival and outcomes. Dis Colon Rectum 50(12):2047–2053 Kondo W, Ribeiro R, Trippia C, Zomer MT (2013) Laparoscopic treatment of deep infiltrating endometriosis affecting the rectosigmoid colon: nodulectomy or segmental resection? Gynecol Obstetric S3:001. doi:10.4172/2161-0932.S3-001 Coelho RF, Chauhan S, Palmer KJ, Rocco B, Patel MB, Patel VR (2009) Robotic-assisted radical prostatectomy: a review of current outcomes. BJU Int 104(10):1428–1435 Ercoli A, D’Asta M, Fagotti A, Fanfani F, Romano F, Baldazzi G, Salerno MG, Scambia G (2012) Robotic treatment of colorectal endometriosis: technique, feasibility and short-term results. Hum Reprod 27(3):722–726 Baik SH, Kwon HY, Kim JS, Hur H, Sohn SK, Cho CH, Kim H (2009) Robotic versus laparoscopic low anterior resection of rectal cancer: short-term outcome of a prospective comparative study. Ann Surg Oncol 16(6):1480–1487 Luca F, Valvo M, Ghezzi TL, Zuccaro M, Cenciarelli S, Trovato C, Sonzogni A, Biffi R (2013) Impact of robotic surgery on sexual and urinary functions after fully robotic nerve-sparing total mesorectal excision for rectal cancer. Ann Surg 257(4):672–678 Kim JY, Kim NK, Lee KY, Hur H, Min BS, Kim JH (2012) A comparative study of voiding and sexual function after total mesorectal excision with autonomic nerve preservation for rectal cancer: laparoscopic versus robotic surgery. Ann Surg Oncol 19(8):2485–2493 D’Annibale A, Pernazza G, Monsellato I, Pende V, Lucandri G, Mazzocchi P, Alfano G (2013) Total mesorectal excision: a comparison of oncological and functional outcomes between robotic and laparoscopic surgery for rectal cancer. Surg Endosc 27(6):1887–1895 Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213 Abrams P, Avery K, Gardener N, Donovan J (2006) The International Consultation on Incontinence Modular Questionnaire: http://www.iciq.net. J Urol 175(3 Pt 1):1063–1066, discussion 1066 Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, Ferguson D, D’Agostino R Jr (2000) The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 26(2):191–208 Lim P, Kang E, Park D (2011) 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. J Robot Surg 5(4):273–278 Roman H, Vassilieff M, Gourcerol G, Savoye G, Leroi AM, Marpeau L, Michot F, Tuech JJ (2011) Surgical management of deep infiltrating endometriosis of the rectum: pleading for a symptom-guided approach. Hum Reprod 26(2):274–281 Nezhat C, Hajhosseini B, King LP (2011) Robotic-assisted laparoscopic treatment of bowel, bladder, and ureteral endometriosis. Jsls 15(3):387–392 Mak TW, Lee JF, Futaba K, Hon SS, Ngo DK, Ng SS (2014) Robotic surgery for rectal cancer: a systematic review of current practice. World J Gastrointest Oncol 6(6):184–193 Park EJ, Cho MS, Baek SJ, Hur H, Min BS, Baik SH, Lee KY, Kim NK (2015) Long-term oncologic outcomes of robotic low anterior resection for rectal cancer: a comparative study with laparoscopic surgery. Ann Surg 261(1):129–137 Baek SJ, Al-Asari S, Jeong DH, Hur H, Min BS, Baik SH, Kim NK (2013) Robotic versus laparoscopic coloanal anastomosis with or without intersphincteric resection for rectal cancer. Surg Endosc 27(11):4157–4163 Shiomi A, Kinugasa Y, Yamaguchi T, Tomioka H, Kagawa H (2014) Robot-assisted rectal cancer surgery: short-term outcomes for 113 consecutive patients. Int J Colorectal Dis 29(9):1105–1111 Kim CW, Kim CH, Baik SH (2014) Outcomes of robotic-assisted colorectal surgery compared with laparoscopic and open surgery: a systematic review. J Gastrointest Surg 18(4):816–830 Papanikolaou IG (2014) Robotic surgery for colorectal cancer: systematic review of the literature. Surg Laparosc Endosc Percutan Tech 24(6):478–483 Tan SJ, Lin CK, Fu PT, Liu YL, Sun CC, Chang CC, Yu MH, Lai HC (2012) Robotic surgery in complicated gynecologic diseases: experience of Tri-Service General Hospital in Taiwan. Taiwan J Obstet Gynecol 51(1):18–25 Antoniou SA, Antoniou GA, Koch OO, Pointner R, Granderath FA (2012) Robot-assisted laparoscopic surgery of the colon and rectum. Surg Endosc 26(1):1–11 Nezhat C, Modest AM, King LP (2013) The role of the robot in treating urinary tract endometriosis. Curr Opin Obstet Gynecol 25(4):308–311 Liu C, Perisic D, Samadi D, Nezhat F (2008) Robotic-assisted laparoscopic partial bladder resection for the treatment of infiltrating endometriosis. J Minim Invasive Gynecol 15(6):745–748 Patel VR, Patil NN, Coughlin G, Dangle PP, Palmer K (2008) Robot-assisted laparoscopic pyeloplasty: a review of minimally invasive treatment options for ureteropelvic junction obstruction. J Robot Surg 1(4):247–252 Ghezzi TL, Luca F, Valvo M, Corleta OC, Zuccaro M, Cenciarelli S, Biffi R (2014) Robotic versus open total mesorectal excision for rectal cancer: comparative study of short and long-term outcomes. Eur J Surg Oncol 40(9):1072–1079 Park SY, Choi GS, Park JS, Kim HJ, Ryuk JP (2013) Short-term clinical outcome of robot-assisted intersphincteric resection for low rectal cancer: a retrospective comparison with conventional laparoscopy. Surg Endosc 27(1):48–55 Darai E, Bazot M, Rouzier R, Coutant C, Ballester M (2008) Colorectal endometriosis and fertility. Gynecol Obstet Fertil 36(12):1214–1217 Collinet P, Leguevaque P, Neme RM, Cela V, Barton-Smith P, Hebert T, Hanssens S, Nishi H, Nisolle M (2014) Robot-assisted laparoscopy for deep infiltrating endometriosis: international multicentric retrospective study. Surg Endosc 28(8):2474–2479 Carbonnel M, Goetgheluck J, Frati A, Even M, Ayoubi JM (2014) Robot-assisted laparoscopy for infertility treatment: current views. Fertil Steril 101(3):621–626 Byrn JC, Hrabe JE, Charlton ME (2014) An initial experience with 85 consecutive robotic-assisted rectal dissections: improved operating times and lower costs with experience. Surg Endosc 28(11):3101–3107 Meuleman C, Tomassetti C, D’Hoore A, Van Cleynenbreugel B, Penninckx F, Vergote I, D’Hooghe T (2011) Surgical treatment of deeply infiltrating endometriosis with colorectal involvement. Hum Reprod Update 17(3):311–326 Bianchi PP, Luca F, Petz W, Valvo M, Cenciarelli S, Zuccaro M, Biffi R (2013) The role of the robotic technique in minimally invasive surgery in rectal cancer. Ecancermedicalscience 7:357 Acknowledgments Study supported by ARPA foundation, www.fondazionearpa.it. Author contributions Study concept and design was done by Morelli, Perutelli, Cela, Guadagni, Di Franco, Palmeri, Mariniello, Di Candio, Salerno and Mosca. Acquisition of data was performed by Morelli, Guadagni, Palmeri, Di Franco, and Mariniello. Analysis and interpretation of data was performed by Morelli, Perutelli, Cela, Salerno Di Candio, and Mosca. Drafting of the manuscript was achieved by Morelli, Guadagni, Brundu and Di Franco. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved was done by Morelli, Di Candio, Salerno and Mosca. Final approval of the version to be published was done by Di Candio, Salerno and Mosca. Author information Authors and Affiliations Corresponding author Ethics declarations Conflict of interest The authors declare that they have no competing interests. Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Rights and permissions About this article Cite this article Morelli, L., Perutelli, A., Palmeri, M. et al. Robot-assisted surgery for the radical treatment of deep infiltrating endometriosis with colorectal involvement: short- and mid-term surgical and functional outcomes. Int J Colorectal Dis 31, 643–652 (2016). https://doi.org/10.1007/s00384-015-2477-2 Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00384-015-2477-2