New technologies in the surgical management of endometriosis

Francesca Massimello, Attilio Di Spiezio Sardo, Giuseppe Bifulco, Stefano Angioni, Vito Cela
In: AboutOpen · 2023 · vol. 10 , pp. 50–54 · doi:10.33393/ao.2023.2547 · W4327967061
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Robotic-assisted laparoscopy is a feasible and safe surgical option for endometriosis, offering benefits in precision and ergonomics, particularly for severe cases, with outcomes comparable to traditional laparoscopy.

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This paper evaluates the emerging role of new surgical technologies in endometriosis, focusing on robotic-assisted laparoscopy, and includes relevant literature from PubMed and the Cochrane Library up to December 2022. It reports that robotic-assisted surgery is feasible and safe and shows complication rates, blood loss, hospitalization, and long-term symptom improvement that are superimposable to standard laparoscopy, though evidence for differences in operative time is contradictory and needs further investigation. The paper highlights that robotic-assisted laparoscopy may offer specific advantages for severe disease because of surgical precision and ergonomics, and it notes that indocyanine green fluorescence angiography has been proposed to help visualize ureteral and bowel anastomotic vascularization to prevent postoperative complications. This paper is centrally about endometriosis—specifically, an overview of how robotic-assisted laparoscopy and fluorescence imaging technologies are used in surgical management of endometriosis.

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Abstract

Introduction: Endometriosis is a very common disease that affects up to 10% of the female population. Although medical therapy represents the first-line treatment for endometriosis, it does not always manage to control symptoms. Laparoscopy represents the standard surgical treatment in endometriosis. Robotic-assisted laparoscopy is an innovative mini-invasive surgical technique. Its application in gynecological surgery and in endometriosis has increased in the last decade. Our purpose is to offer an overview of the role of robotic-assisted laparoscopy in the surgical treatment of endometriosis. Methods: We evaluated studies dealing with the new technique in surgery for endometriosis with a focus on robotic surgery. We performed a compressive literature research on PubMed and the Cochrane Library in December 2022. Expert opinion: Robotic-assisted surgery is a feasible and safe approach to endometriosis surgery and is superimposable to laparoscopy in terms of complication rate, blood loss, hospitalization, and long-term improvement of symptoms. The effect of robotic-assisted surgery on operative time is still contradictory and needs to be further investigated. Robotic-assisted laparoscopic surgery can provide particular benefit in the management of women with severe endometriosis secondary to its advantage in surgical precision and ergonomics. Indocyanine green fluorescence angiography could be useful to assist in the vascularization of ureters and bowel anastomosis, to prevent postoperative complication and leakage.
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Introduction

Endometriosis is a very common disease that affects up to 10% of the female population. Although medical therapy represents the first-line treatment for endometriosis, it does not always manage to control symptoms. Laparoscopy represents the standard surgical treatment in endometriosis. Robotic-assisted laparoscopy is an innovative mini-invasive surgical technique. Its application in gynecological surgery and in endometriosis has increased in the last decade. Our purpose is to offer an overview of the role of robotic-assisted laparoscopy in the surgical treatment of endometriosis.

Methods

We evaluated studies dealing with the new technique in surgery for endometriosis with a focus on robotic surgery. We performed a compressive literature research on PubMed and the Cochrane Library in December 2022. Expert opinion: Robotic-assisted surgery is a feasible and safe approach to endometriosis surgery and is superimposable to laparoscopy in terms of complication rate, blood loss, hospitalization, and long-term improvement of symptoms. The effect of robotic-assisted surgery on operative time is still contradictory and needs to be further investigated. Robotic-assisted laparoscopic surgery can provide particular benefit in the management of women with severe endometriosis secondary to its advantage in surgical precision and ergonomics. Indocyanine green fluorescence angiography could be useful to assist in the vascularization of ureters and bowel anastomosis, to prevent postoperative complication and leakage.

References

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