Skip to main content
SpringerLink
Log in

Application of robotic single-site surgery with optional additional port for endometriosis: a single institution’s experience

  • Original Article
  • Published:
Journal of Robotic Surgery Aims and scope Submit manuscript

Abstract

To evaluate the safety and feasibility of treating stage I–IV endometriosis patients with robotic single-site surgery (RSSS). A retrospective chart review was conducted on 334 patients with endometriosis treated by a single surgeon at a university hospital from January 2015 to November 2019. Surgeries were performed in a single institution between 2015 and 2019. All patients presented with pelvic pain and underwent surgical resection of the lesion. American Society of Reproductive Medicine (ASRM) standards were used to classify endometriosis. The primary goal of this study is to investigate the feasibility and safety of RSSS for surgical resection of stage I–IV endometriosis patients. We will compare patient characteristics and surgical parameters, such as blood loss, operating time, and postoperative complications, across different endometriosis stages to evaluate the effectiveness of this novel technique. RSSS was used for all cases, with no conversions to laparotomy or traditional laparoscopy. One to two additional ports were placed in 41 patients with deeply infiltrating endometriosis (DIE) involving the colorectal and urinary tract and/or extensive pelvic adhesions. Across patient groups, there were no significant differences in age, BMI, fertility history, abdominal surgery history, and hysterectomy ratio (P > 0.05). The median operation time was 140.25 min (range: 85.50–260.00 min, P < 0.05) and median blood loss was 31.25 mL (range: 15–100 mL, P < 0.05). Histopathology supported the diagnosis in 259/334 patients. The undiagnosed patients were associated with lower ASRM scores. For 83.3% of patients (295/334), the length of hospital stay was < 24 h. The postoperative complication rate was 6.0% (20/334), although only two cases were severe. Our results indicate that RSSS is an alternative, safe, and acceptable platform for the surgical treatment of all stages of endometriosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Giudice LC, Kao LC (2004) kaoLC. Endometriosis Lancet 364(9447):1789–1799

    Article  Google Scholar 

  2. Balasch J, Creus M, Fa’bregues F et al (1996) Visible and nonvisible endometriosis at laparoscopy in fertile and infertile women and in patients with chronic pelvic pain: a prospective study. Hum Reprod 11(2):387–391

    Article  CAS  Google Scholar 

  3. Leibson CL, Good AE, Hass SL et al (2004) Incidence and characterization of diagnosed endometriosis in a geographically defined population. Fertil Steril 82(2):314–321

    Article  Google Scholar 

  4. Practice Committee of the American Society for Reproductive M (2014) Treatment of pelvic pain associated with endometriosis: a committee opinion. Fertil Steril 101:927–935

    Article  Google Scholar 

  5. Nezhat C, Nezhat F (2012) Endometriosis: ancient disease, ancient treatments. Fertil Steril 98(6 Suppl):S1–S62

    Article  Google Scholar 

  6. Bedaiwy MA, Farghaly T, Hurd W et al (2014) Laparoendoscopic single-site surgery for management of ovarian endometriomas. JSLS 18:191–196

    Article  Google Scholar 

  7. Scheib SA, Fader AN (2015) Gynecologic robotic laparoendoscopic single-site surgery: prospective analysis of feasibility, safety, and technique. Am J Obstet Gynecol 212:179.e1-179.e8

    Article  Google Scholar 

  8. Eom JM, Ko JH, Choi JS, Hong JH, Lee JH (2013) A comparative cross sectional study on cosmetic outcomes after single port or conventional laparoscopic surgery. Eur J Obstet Gynecol Reprod Biol 167:104–109

    Article  Google Scholar 

  9. Hirasawa Y et al (2014) Laparoendoscopic single-site adrenalectomy versus conventional laparoscopic adrenalectomy: a comparison of surgical outcomes and an analysis of a single surgeon’s learning curve. Surg Endosc 28:2911–2919

    Article  Google Scholar 

  10. Grochola LF et al (2017) Robot-assisted single-site compared with laparoscopic single-incision cholecystectomy for benign gallbladder disease: protocol for a randomized controlled trial. BMC Surg 17:13

    Article  Google Scholar 

  11. Samarasekera D, Kaouk JH (2014) Robotic single port surgery: current status and future considerations. Indian J Urol 30:326–332

    Article  Google Scholar 

  12. Frick AC, Barakat EE, Stein RJ, Mora M, Falcone T (2011) Robotic assisted laparoscopic management of ureteral endometriosis. JSLS 15(3):396–399

    Article  Google Scholar 

  13. Nezhat C, Hajhosseini B, King LP (2011) Robotic-assisted laparoscopic treatment of bowel, bladder, and ureteral endometriosis. JSLS 15:387–392

    Article  Google Scholar 

  14. Liu C, Perisic D, Samadi D, Nezhat F (2008) Robotic-assisted laparoscopic partial bladder resection for the treatment of infiltrating endometriosis. J Minim Invasive Gynecol 15:745–748

    Article  CAS  Google Scholar 

  15. Ercoli A, D’asta M, Fagotti A, Fanfani F, Romano F, Baldazzi G et al (2012) Robotic treatment of colorectal endometriosis: technique, feasibility and short-term results. Hum Reprod 27:722–726

    Article  CAS  Google Scholar 

  16. Abo C, Roman H, Bridoux V, Huet E, Tuech JJ, Resch B et al (2016) Management of deep infiltrating endometriosis by laparoscopic route with robotic assistance: 3-year experience. J Gynecol Obstet Biol Reprod (Paris) 46(1):9–18

    Google Scholar 

  17. Guan X, Nguyen MTA, Walsh TM, Kelly B (2016) Robotic single-site endometriosis resection using firefly technology. J Minim Invasive Gynecol 23:10–11

    Article  Google Scholar 

  18. Jayakumaran J et al (2020) Robotic single-site endometriosis resection using near-infrared fluorescence imaging with indocyanine green: a prospective case series and review of literature. J Robot Surg 14:145–154

    Article  Google Scholar 

  19. Gargiulo AR, Feltmate C, Srouji SS (2015) Robotic single-site excision of ovarian endometrioma. Fertil Res Pract 1:19

    Article  Google Scholar 

  20. Moon HS, Shim JE, Lee SR, Jeong K (2018) The comparison of robotic single-site surgery to single-port laparoendoscopic surgery for the treatment of advanced-stage endometriosis. J Laparoendosc Adv Surg Tech A 28(12):1483–1488

    Article  Google Scholar 

  21. Canis M, Donnez JG, Guzick DS, Halme JK, Rock JA, Schenken RS, Vernon MW (1997) Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril. 67(5):817–821

    Article  Google Scholar 

  22. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  Google Scholar 

  23. Pasic RP, Rizzo JA, Fang H, Ross S, Moore M, Gunnarsson C (2010) Comparing robot-assisted with conventional laparoscopic hysterectomy: impact on cost and clinical outcomes. J Minim Invasive Gynecol 17:730–738

    Article  Google Scholar 

  24. Nezhat C, Lewis M, Kotikela S et al (2010) Robotic versus standard laparoscopy for the treatment of endometriosis. Fertil Steril 94:2758–2760

    Article  Google Scholar 

  25. Nezhat CR, Stevens A, Balassiano E, Soliemannjad R (2015) Robotic-assisted laparoscopy vs conventional laparoscopy for the treatment of advanced stage endometriosis. J Minim Invasive Gynecol 22:40–44

    Article  Google Scholar 

  26. Mosbrucker C, Somani A, DulembaJ, et al (2018) Visualization of endometriosis: comparative study of 3-dimensional robotic and 2-dimensional laparoscopic endoscopes. J Robot Surg 12(1):59–66

    Article  Google Scholar 

  27. Soto E, Luu TH, Liu X et al (2017) Laparoscopy vs Robotic Surgery for Endometriosis (LAROSE): a multicenter, randomized, controlled trial. Fertil Steril 107(4):996–1002

    Article  Google Scholar 

  28. Bedaiwy MA, Abdel Rahman MY, Chapman M et al (2013) Robotic-assisted hysterectomy for the management of severe endometriosis: a retrospective review of short-term surgical outcomes. JSLS 17:95–99

    Article  Google Scholar 

  29. Magrina JF, Espada M, Kho RM et al (2015) Surgical excision of advanced endometriosis: perioperative outcomes and impacting factors. J Minim Invasive Gynecol 22(6):944–950

    Article  Google Scholar 

  30. Morales-Conde S, Peeters A, Meyer YM et al (2019) European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery. Surg Endosc 33(4):996–1019

    Article  Google Scholar 

  31. Clark NV, Dmello M, Griffith KC et al (2020) Laparoscopic treatment of endometriosis and predictors of major complications: a retrospective cohort study. Acta Obstet Gynecol Scand 99(3):317–323

    Article  Google Scholar 

  32. Antoniou SA, García-Alamino JM, Hajibandeh S et al (2018) Single-incision surgery trocar-site hernia: an updated systematic review meta-analysis with trial sequential analysis by the Minimally Invasive Surgery Synthesis of Interventions Outcomes Network (MISSION). Surg Endosc 32(1):14–23

    Article  Google Scholar 

  33. Marchino GL, Gennarelli G, Massobrio M, Enria R et al (2005) Diagnosis of pelvic endometriosis with use of macroscopic versus histologic findings. Fertil Steril 84:12–15

    Article  Google Scholar 

  34. Falcone T, Lebovic DI (2011) Clinical management of endometriosis. Obstet Gynecol 118:691–705

    Article  CAS  Google Scholar 

  35. Vercellini P, Viganò P, Somigliana E, Fedele L (2014) Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol 10:261

    Article  CAS  Google Scholar 

  36. Prefumo F, Todeschini F, Fulcheri E, Venturini PL (2002) Epithelial abnormalities in cystic ovarian endometriosis. Gynecol Oncol 84:280

    Article  Google Scholar 

Download references

Funding

No additional funding was received for this study.

Author information

Authors and Affiliations

  1. Division of Minimally Invasive Gynecologic Surgery, Baylor College of Medicine, 6651 Main Street, 10th floor, Houston, TX, 77030, USA

    Yi Huang, Kristina Duan, Tamisa Koythong & Xiaoming Guan

  2. Department of Gynecology, The Second School of Clinical Medicine, Nanhai People’s Hospital, Southern Medical University, Foshan, 528200, Guangdong, China

    Yi Huang

  3. Department of Pathology, Baylor College of Medicine, Houston, TX, 77030, USA

    Ninad M. Patil

  4. Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China

    Dazhi Fan

  5. Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong, China

    Juan Liu & Zhenkun Guan

Authors
  1. Yi Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kristina Duan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tamisa Koythong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ninad M. Patil
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dazhi Fan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Juan Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Zhenkun Guan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Xiaoming Guan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xiaoming Guan.

Ethics declarations

Conflict of interest

Dr. Y Huang, Dr. K Duan, Dr. T Koythong, Dr. N Patil, Dr. D Fan, Dr. J Liu, Dr. Z Guan, Dr. X Guan declare that they have no financial disclosures or conflicts of interests.

Ethical approval

The study protocol was reviewed and approved by the institutional review board at Baylor College of Medicine in 2018 (Reference Number No. H-46727).

IRB approval

The IRB review board has approved this research at our institution (Ethic Number No. H-46727).

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Huang, Y., Duan, K., Koythong, T. et al. Application of robotic single-site surgery with optional additional port for endometriosis: a single institution’s experience. J Robotic Surg 16, 127–135 (2022). https://doi.org/10.1007/s11701-021-01217-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11701-021-01217-4

Keywords

Search

Navigation