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Peri-operative outcomes of patients with stage IV endometriosis undergoing robotic-assisted laparoscopic surgery

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Abstract

We analyzed peri-operative outcomes of 80 patients who underwent robotic-assisted laparoscopic surgery and were diagnosed with stage IV endometriosis (revised American Society for Reproductive Medicine) between January 2007 and December 2010 at a tertiary gynecologic oncology referral center with a fellowship training program. Eligible women had a combination of one or more factors: pelvic mass, sub-acute or chronic pelvic pain, dysmenorrhea, dyspareunia, elevated serum CA-125, diagnosed with stage IV endometriosis at surgery with robotic-assisted gynecologic procedures using the da Vinci® Surgical System. The mean age was 43.7 ± 7.0 years, body mass index 27.5 ± 7.4 kg/m2, and 23 (28.9%) patients had prior endometriosis surgery. Presenting symptoms included: chronic pelvic pain (48.8%), dysmenorrhea (40.3%), and dyspareunia (33.8%). Sixty-nine (86%) patients had pelvic masses (43 unilateral and 26 bilateral). Thirty-seven (46.3%) had elevated CA-125 levels (mean 97.9 ± 71.6 U/ml). Forty-eight (60%) underwent robotic-assisted laparoscopic hysterectomy (RALH)/bilateral salpingo-oophorectomy (BSO), 9 (11.3%) RALH/unilateral salpingo-oophorectomy (USO), 5 (6.3%) modified radical hysterectomy, and 10 (13%) USO or BSO only. Four (5%) had ovarian cystectomies with excision of endometriotic implants. Three (3.8%) underwent appendectomy and no patient required bowel resection. Four (5%) patients required conversion to laparotomy during the first 15 cases of this series [dense adhesions (3) and ureteral injury (1)]. Mean operative time was 115 ± 46 min, blood loss 88 ± 67 ml, and length of stay 1.0 ± 0.4 days. There were four (5%) complications (ureteral injury, cuff abscess, cuff hematoma, re-admission for nausea and vomiting secondary to narcotics) and no transfusions. One (1.3%) patient underwent a second surgery for pain (dyspareunia). Robotic-assisted surgery for stage IV endometriosis resulted in excellent pain relief, with few laparotomy conversions or complications during a robotic learning-curve experience.

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Authors and Affiliations

  1. Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute, 2501 N. Orange Ave., Suite 800, Orlando, FL, 32804, USA

    Lorna A. Brudie, Sarfraz Ahmad, Neil J. Finkler, Glenn E. Bigsby IV, Giselle B. Ghurani, James E. Kendrick IV, Joseph A. Rakowski, Jessica H. Groton & Robert W. Holloway

  2. Obstetrics and Gynecology, IRCCS-Fondazione Policlinico San Matteo and University of Pavia, Pavia, 27100, Italy

    Giorgia Gaia

Authors
  1. Lorna A. Brudie
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  2. Giorgia Gaia
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  3. Sarfraz Ahmad
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  4. Neil J. Finkler
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  5. Glenn E. Bigsby IV
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  6. Giselle B. Ghurani
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  7. James E. Kendrick IV
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  8. Joseph A. Rakowski
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  9. Jessica H. Groton
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  10. Robert W. Holloway
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Correspondence to Lorna A. Brudie.

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Brudie, L.A., Gaia, G., Ahmad, S. et al. Peri-operative outcomes of patients with stage IV endometriosis undergoing robotic-assisted laparoscopic surgery. J Robotic Surg 6, 317–322 (2012). https://doi.org/10.1007/s11701-011-0314-3

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  • DOI: https://doi.org/10.1007/s11701-011-0314-3

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