Robotic Natural Orifice Specimen Extraction with Totally Intracorporeal Anastomosis Associated with Firefly Fluorescence: Bowel Resection for Deep Infiltrating Endometriosis

André Luiz Gioia Morrell, Gladis Maria Pacileo Anchieta Rodrigues Ribeiro, Thiago Pareja dos Santos, Alexander Charles Morrell, Luciana Pardini Chamié, Nathalia Frare, P. Serafini, Duarte Miguel Ferreira Rodrigues Ribeiro
In: Journal of Gynecologic Surgery · 2020 · vol. 36(3) , pp. 128–135 · doi:10.1089/gyn.2019.0139 · W3012513561
article OA: closed CC0 ⤵ 1 in-corpus citation
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This study investigated robotic natural orifice specimen extraction with totally intracorporeal anastomosis and Firefly fluorescence for bowel resection in 56 patients with deep infiltrating endometriosis, finding it safe and feasible.

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Abstract

Objective: The aim of this study was to explore the effects and applications of a robotic minimally invasive bowel-segmental resection, following intracorporeal anastomosis for treatment of deep infiltrating endometriosis (DIE). The procedure reconciled a totally intracorporeal anastomosis (TIA) procedure and robotic natural-orifice specimen extraction (R-NOSE) associated with Firefly™ fluorescence (F) technology (Intuitive Surgical Inc., Sunnyvale, CA) for optimizing outcomes in colon and rectal resection. The authors' initial group experience is also mentioned. Materials and Methods: Fifty-six patients with DIE of the colon and rectum underwent the surgical procedure in a tertiary-care referral institution for endometriosis. A standardized robotic procedure was performed with bowel resection and indocyanine green–induced F used for bowel-perfusion assessment. Specimen withdrawal was performed through natural orifices. Patients underwent the surgical procedures from December 2015 to October 2019. Surgical outcomes data and patient follow-ups are reported. Results: All patients had robotic minimally invasive bowel segmental resection, following intracorporeal anastomosis. The group's mean age was 36.8 (range: 28–46 years); with a mean body mass index of 22.88 kg/m2 (range: 18.9–28.3 kg/m2). In all cases, end-to-end position anastomoses were performed, using a circular stapler; no conversion or diverting stoma were needed. All patients had indocyanine F imaging assessment for bowel and anastomosis perfusion. Mean hospitalization was 4.5 days (range: 3–6 days), and no mortality occurred. No anastomotic leakage or rectovaginal fistula were observed. Conclusions: R-NOSE with TIA including Firefly F is a safe and feasible minimally invasive approach to benign bowel disease, reconciling prevalent procedures for endometriosis and colorectal surgical treatment. (J GYNECOL SURG 36:128)

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endometriosisdie_deep_infiltrating

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