Innovations in Robotic Surgery: Fertility Sparing Stage IV Endometriosis Resection With the DaVinci Single-Port (SP) System

OBJECTIVE: To show a complex fertility-sparing resection of stage IV endometriosis with the DaVinci Single-Port (SP) Robot system and to provide tips and tricks for surgical skill and efficiency when using this newer robot system for gynecologic surgery. SETTING: Single academic center. PARTICIPANT: The patient was a 37-year-old female with lifelong dysmenorrhea, dyschezia and hematochezia. She had failed medical management and desired surgical intervention. The workup included a magnetic resonance imaging that showed evidence of deep infiltrating endometriosis with nodules on the rectum and vesicouterine space. As she desired future fertility, she was scheduled for a robotic endometriosis resection in combination with colorectal surgery. INTERVENTIONS: The educational video with a narrated approach of a complex stage IV endometriosis resection with the goal of completely excising the endometriosis burden while preserving fertility. The surgery was performed with the DaVinci SP Robot in a minimally invasive fashion and shows lysis of adhesions, bilateral ureterolysis, retroperitoneal dissection, and a low anterior resection by colorectal surgery. CONCLUSION: This video demonstrates that gynecologic surgeries such as a stage IV endometriosis resections can be successfully performed with the DaVinci SP System. It highlights tips and tricks for surgical skills involved in completely excising endometriosis implants while preserving pelvic organs in patients who desire future fertility. This video also provides instruction on how this newer robot system is beneficial for complex surgeries, including a low anterior bowel resection given the size and location of the slightly larger incision required for the single-site port device, all while maintaining a minimally invasive approach. Finally, the video highlights unique features of the SP system, such as triangulation and an example incision closure, to assist surgeons who are interested in using this robot for gynecologic surgery. VIDEO ABSTRACT.