Deep Infiltrating Colorectal Endometriosis Treated With Robotic-Assisted Rectosigmoidectomy

Background and Objective: Deep infiltrating pelvic endometriosis with bowel involvement is one of the most aggressive forms of endometriosis. Nowadays, ro-botic technology and telemanipulation systems repre-sent the latest developments in minimally invasive sur-gery. The aim of this study is to present our preliminary results and evaluate the feasibility of robotic-assisted laparoscopic colorectal resection for severe endometri-osis. Methods: Between September 2009 and December 2011, 10 women with colorectal endometriosis underwent sur-gery with the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, CA, USA). We evaluated the follow-ing parameters: short-term complications, clinical out-comes and long-term follow-up, pain relief recurrence rate, and fertility outcomes. Results: Extensive ureterolysis was required in 8 women (80%). Ovarian cystectomy with removal of the cystic wall was performed in 7 women (70%). Torus resection was performed in all women, with unilateral and bilateral uterosacral ligament resection in 1 woman (10%) and 8 women (80%), respectively. In addition to segmental colo-rectal resection in all cases, partial vaginal resection was necessary in 2 women (20%). An appendectomy was performed in 2 patients (20%). The mean operative time with the robot was 157 minutes (range, 90–190 minutes). The mean hospital stay was 3 days. Six patients had infertility before surgery, with a mean infertility time of 2 years. After a 12-month follow-up period, 4 women (67%) conceived naturally and 2 (33%) underwent in vitro fertil-ization. Conclusion: We show that robotic-assisted laparoscopic surgery for the treatment of deep infiltrating bowel endo-metriosis is feasible, effective, and safe.