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Robot-assisted total intracorporeal low anterior resection with primary anastomosis and radical dissection for treatment of stage IV endometriosis with bowel involvement: morbidity and its outcome

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Robot-assisted low anterior resection with primary sigmoid rectal anastomosis/ureterolysis/hysterectomy with bilateral salpingo-oophorectomy (RALARH), and exploratory laparotomy low anterior resection with primary sigmoid rectal anastomosis/ureterolysis/hysterectomy with bilateral salpingo-oophorectomy (ELLARH). A total of eighteen patients (8 RALARH and 10 ELLARH) met the inclusion criteria. The mean age of the RALARH group was 47 and that of the ELLARH group was 36.9. There was no difference between body mass index (RALARH = 30.3 ± 6.6, 95% CI (25.7, 56.0) vs. ELLARH = 26.7 ± 7.5). Total operative time for the RALARH group was 238.5 ± 57.8 min, 95% CI: (164.5, 279.9) whereas that for the ELLARH group was 237 ± 117.7 min. There were no statistically significant differences between blood loss (RALARH = 425 ± 462.1 cc, 95% CI: (104.8, 745.2). ELLARH = 630 ± 432.2 cc) or days of hospitalization (RALARH = 5.5 ± 2.4 days, 95% CI: (3.8, 7.2) vs. ELLARH = 6.2 ± 1.6 days) in the RALARH and ELLARH groups. There were fewer complications in the RALARH group than in the ELLARH group (RALARH two complications vs. ELLARH two blood transfusion and two rectovaginal fistula), but the difference was not significant because of the small sample size. Robotic low anterior resection with primary sigmoid rectal anastomosis with ureterolysis at the time of hysterectomy and bilateral salpingo-oophorectomy for treatment of Stage IV endometriosis is a feasible and safe procedure.

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  1. Prystowsky JB, Stryker SJ, Ujiki GT et al (1988) Gastrointestinal endometriosis incidence and indications for resection. Arch Surg 123:855–858

    PubMed  CAS  Google Scholar 

  2. Weed JC, Ray JE (1987) Endometriosis of the bowel. Obstet Gynecol 69:727–730

    PubMed  CAS  Google Scholar 

  3. Woods RJ, Herior AG, Chen FC (2003) Anterior rectal wall excision for endometriosis using the circular stapler. ANZ J Surg 73:647–648. doi:10.1046/j.1445-2197.2003.02706.x

    Article  PubMed  Google Scholar 

  4. Coronado C, Bailey HR, Franklin RR et al (1990) Surgical treatment of symptomatic colorectal endometriosis. Fertil Steril 53:411–416

    PubMed  CAS  Google Scholar 

  5. Redwine DB, Sharpe DR (1991) Laparoscopic segmental resection of the sigmoid colon for endometriosis. J Laparoendosc Surg 1:217–220. doi:10.1097/00129689-199206000-00006

    Article  PubMed  CAS  Google Scholar 

  6. Nezhat C, Nezhat F, Pennington E (1992) Laparoscopic treatment of infiltrative rectosigmoid colon and rectovaginal septum endometriosis by the technique of video laparoscopy and the CO2 laser. Br J Obstet Gynaecol 99:664–667

    Article  PubMed  CAS  Google Scholar 

  7. Jerby BL, Kessler H, Falcone T, Milsom JW (1999) Laparoscopic management of colorectal endometriosis. Surg Endosc 13:1123–1128. doi:10.1007/s004649901187

    Article  Google Scholar 

  8. Jatan AK, Solomon MJ, Young J, Cooper M, Pathma-Nathan N (2006) Laparoscopic management of rectal endometriosis. Dis Colon Rectum 49:169–174. doi:10.1007/s10350-005-0264-9

    Article  PubMed  Google Scholar 

  9. Lenihan JP, Kovanda C, Seshadri-Kreasden U (2008) What is the learning curve for robotic assisted gynecologic surgery? J Minim Invasive Gynecol 15:589–594. doi:10.1016/j.jmig.2008.06.015

    Article  PubMed  Google Scholar 

  10. Advincula AP, Xu X, Goudeau S IV, Ransom SB (2007) Robotic assisted laparoscopic myomectomy versus abdominal myomectomy: a comparison of short-term surgical outcomes and immediate costs. J Minim Invasive Gynecol 14:698–705. doi:10.1016/j.jmig.2007.06.008

    Article  PubMed  Google Scholar 

  11. Payne TN, Dauterive FR (2008) A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice. J Minim Invasive Gynecol 15:286–291. doi:10.1016/j.jmig.2008.01.008

    Article  PubMed  Google Scholar 

  12. Remorgida V, Ragni N, Ferrero S, Anserini P, Torelli P, Fulcheri E (2005) How complete is full thickness disc resection of bowel endometriotic lesions? A prospective surgical histological study. Human Reprod 20:2317–2320. doi:10.1093/humrep/dei047

    Article  CAS  Google Scholar 

  13. Sharpe DR, Redwine DB (1992) Laparoscopic segmental resection of the sigmoid and rectosigmoid colon for endometriosis. Surg Laparosc Endosc 2:120–124. doi:10.1097/00129689-199206000-00006

    Article  PubMed  CAS  Google Scholar 

  14. Ruffo G, Scopelliti F, Scioscia M, Ceccaroni M, Mainardi P, Miinelli L (2009) Laparoscopic colorectal resection for deep infiltrating endometriosis: analysis of 436 cases. Surg Endosc 24:63–67. doi:10.1007/s00464-009-0517-0

    Article  PubMed  Google Scholar 

  15. Darai E, Ackerman G, Bazot M, Rouzier R, Dubernard G (2007) Laparoscopic segmental colorectal resection for endometriosis: limits and complications. Surg Endosc 21:1572–1577. doi:10.1007/s00464-006-9160-1

    Article  PubMed  CAS  Google Scholar 

  16. Campagnacci R, Perretta S, Guerrieri M, Paganini AM, De Sanctis A, Ciavattini A, Lezzoshe E (2005) Laparoscopic colorectal resection for endometriosis. Surg Endosc 19:662–664. doi:10.1007/s00464-004-8710-7

    Article  PubMed  CAS  Google Scholar 

  17. Possover M, Diebolder H, Plaul K, Schneider A (2000) Laparoscopically assisted vaginal resection of rectovaginal endometriosis. Obstet Gynecol 96:304–307. doi:10.1016/S0029-7844(00)00839-5

    Article  PubMed  CAS  Google Scholar 

  18. Redwine DB, Koning M, Sharpe DR (1996) Laparoscopically assisted transvaginal segmental resection of the rectosigmoid colon for endometriosis. Fertil Steril 65:193–197

    PubMed  CAS  Google Scholar 

  19. Pagazzi A, Ellenhorn DI, Ballantyne GH, Paz IB (2006) Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc 20:1521–1525. doi:10.1007/s00464-005-0855-5

    Article  Google Scholar 

  20. Reich H, Redan JA, Orbuch IK (2004) Laparoscopic hysterectomy for advanced endometriosis including rectosigmoid disease. Surg Technol Int 13:121–136

    PubMed  Google Scholar 

  21. Chammas MF, Kim FJ, Barbarino A, Hubert BN, Feuillu B, Coissard A, Hubert J (2008) Asymptomatic rectal and bladder endometriosis: a case for robotic assisted- surgery. Can J Urol 15(3):4097–4100

    PubMed  Google Scholar 

  22. Darai E, Thomassin I, Barranger E, Detchev R, Cortez A, Houry S, Bazot M (2005) Feasibility and clinical outcome of laparoscopic colorectal resection for endometriosis. Am J Obstet Gynecol 192:394–400. doi:10.1016/j.ajog.2004.08.033

    Article  PubMed  Google Scholar 

  23. Duepree HJ, Senagore AJ, Delancey CP, Marceloo PW, Brady KM, Falcone T (2002) Laparoscopic resection of deep pelvic endometriosis with rectosigmoid involvement. J Am Coll Surg 195:754–758. doi:10.1016/S1072-7515(02)01341-8

    Article  PubMed  Google Scholar 

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Correspondence to Peter C. Lim.

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Lim, P.C., Kang, E. & Park, D.H. Robot-assisted total intracorporeal low anterior resection with primary anastomosis and radical dissection for treatment of stage IV endometriosis with bowel involvement: morbidity and its outcome. J Robotic Surg 5, 273–278 (2011).

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