Initial experience of robotically assisted endometriosis surgery with a novel robotic system: first case series in a tertiary care center

Endometriosis is a benign disease requiring surgery if medical treatment can not achieve symptom control. Laparoscopy remains the gold standard and robotic assistance can be beneficial in complex cases. Robot-assisted radical endometriosis excision using the Hugo™ RAS system is a novel approach. The aim of this study is to describe its setting and outcomes in a series of patients in a robotic surgery center. Endometriosis patients who consecutively underwent robot-assisted surgery with the Hugo™ RAS system (Medtronic, USA) were retrospectively enrolled. Disease-specific symptoms before and after surgery, endometriosis stage, as well as perioperative and intraoperative variables including system setup were collected. Early post-operative complications (< 30 days) and follow-up (up to 3 months) were reported. All procedures were completed robotically. Port placement followed the “bridge” configuration with a “compact” docking. The median operative time was 186.5 min (IQR 174–220), the median estimated blood loss 50 ml (IQR 0–100). An intraoperative complication occurred in one patient (6.6%), a bladder laceration with postoperative antibiotic treatment. The median lenght of hospital stay (LOS) was 3 days (IQR 3–4). Surgery achieved a statistically significant decrease in symptoms: mean dysmenorrhea (9.50 ± 0.83 versus 1.7 ± 2.26; p = 0.001), dyschezia (4.27 ± 3.61 versus 2.40 ± 2.92; p = 0.026), dysuria (2.73 ± 3.39 versus 1.87 ± 2.41; p = 0.358), dyspareunia (6.53 ± 3.15 versus 2.93 ± 2.89; p = 0.002) and chronic pelvic pain (8.8 ± 1.20 versus 3.20 ± 2.39; p = 0.001). The integration of this platform in the described configuration was safe with regular perioperative outcomes and significant improvement in symptoms. Prospective comparative studies with a larger cohort and longer follow-up are needed to assess potential advantages over the current gold standard. Similar content being viewed by others Data availability statement The original data presented in the study are provided. Further enquiries can be directed to the corresponding author.

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Analysis and interpretation of data: MP, BS, MG. Manuscript drafting: MP, BS and MMI. Critical revision of manuscript: GS, MMI. All authors have reviewed the manuscript and approved the final version before submission. Corresponding author Ethics declarations Conflict of interest Matteo Pavone, Maria Vittoria Alesi, Marta Goglia, Prof. Giovanni Scambia and Manuel Maria Ianieri, have no conflicts of interest or financial ties to disclose. Prof. Barbara Seeliger has a research and education consultant agreement with CMR Surgical and Intuitive Surgical. Ethical approval This retrospective study was conducted in accordance with the principles of the Declaration of Helsinki and approved by the Institutional Review Board. Patients signed an informed consent specific to the use of the novel robotic platform and agreed with the use of their data for scientific purpose. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Pavone, M., Seeliger, B., Alesi, M.V. et al. Initial experience of robotically assisted endometriosis surgery with a novel robotic system: first case series in a tertiary care center. Updates Surg 76, 271–277 (2024). https://doi.org/10.1007/s13304-023-01724-z Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s13304-023-01724-z