Initial experience of robotically assisted endometriosis surgery with a novel robotic system: first case series in a tertiary care center.
Docking
Endometriosis
Minimally invasive surgery
Robotic surgery
Journal
Updates in surgery
ISSN: 2038-3312
Titre abrégé: Updates Surg
Pays: Italy
ID NLM: 101539818
Informations de publication
Date de publication:
22 Dec 2023
22 Dec 2023
Historique:
received:
12
06
2023
accepted:
01
12
2023
medline:
22
12
2023
pubmed:
22
12
2023
entrez:
22
12
2023
Statut:
aheadofprint
Résumé
Endometriosis is a benign disease requiring surgery if medical treatment can not achieve symptom control. Laparoscopy remains the gold standard and robotic assistance can be beneficial in complex cases. Robot-assisted radical endometriosis excision using the Hugo™ RAS system is a novel approach. The aim of this study is to describe its setting and outcomes in a series of patients in a robotic surgery center. Endometriosis patients who consecutively underwent robot-assisted surgery with the Hugo™ RAS system (Medtronic, USA) were retrospectively enrolled. Disease-specific symptoms before and after surgery, endometriosis stage, as well as perioperative and intraoperative variables including system setup were collected. Early post-operative complications (< 30 days) and follow-up (up to 3 months) were reported. All procedures were completed robotically. Port placement followed the "bridge" configuration with a "compact" docking. The median operative time was 186.5 min (IQR 174-220), the median estimated blood loss 50 ml (IQR 0-100). An intraoperative complication occurred in one patient (6.6%), a bladder laceration with postoperative antibiotic treatment. The median lenght of hospital stay (LOS) was 3 days (IQR 3-4). Surgery achieved a statistically significant decrease in symptoms: mean dysmenorrhea (9.50 ± 0.83 versus 1.7 ± 2.26; p = 0.001), dyschezia (4.27 ± 3.61 versus 2.40 ± 2.92; p = 0.026), dysuria (2.73 ± 3.39 versus 1.87 ± 2.41; p = 0.358), dyspareunia (6.53 ± 3.15 versus 2.93 ± 2.89; p = 0.002) and chronic pelvic pain (8.8 ± 1.20 versus 3.20 ± 2.39; p = 0.001). The integration of this platform in the described configuration was safe with regular perioperative outcomes and significant improvement in symptoms. Prospective comparative studies with a larger cohort and longer follow-up are needed to assess potential advantages over the current gold standard.
Identifiants
pubmed: 38133880
doi: 10.1007/s13304-023-01724-z
pii: 10.1007/s13304-023-01724-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Fondation de l'Avenir pour la Recherche Médicale Appliquée
ID : ANR-10-IAHU-02
Informations de copyright
© 2023. Italian Society of Surgery (SIC).
Références
Giudice LC (2010) Clinical practice. Endometriosis. N Engl J Med 362(25):2389–2398. https://doi.org/10.1056/nejmcp1000274
doi: 10.1056/nejmcp1000274
pubmed: 20573927
pmcid: 3108065
Ianieri MM, Buca DIP, Panaccio P, Cieri M, Francomano F, Liberati M (2017) Retroperitoneal endometriosis in postmenopausal woman causing deep vein thrombosis: case report and review of the literature. Clin Exp Obstet Gynecol 44(1):148–150
doi: 10.12891/ceog3306.2017
pubmed: 29714887
Dunselman GAJ, Vermeulen N, Becker C, Calhaz-Jorge C, D’Hooghe T, De Bie B et al (2014) ESHRE guideline: management of women with endometriosis. Hum Reprod Oxf Engl 29(3):400–412. https://doi.org/10.1093/humrep/det457
doi: 10.1093/humrep/det457
Luu TH, Uy-Kroh MJ (2017) New developments in surgery for endometriosis and pelvic pain. Clin Obstet Gynecol 60(2):245–251. https://doi.org/10.1097/GRF.0000000000000282
doi: 10.1097/GRF.0000000000000282
pubmed: 28288013
Restaino S, Mereu L, Finelli A, Spina MR, Marini G, Catena U et al (2020) Robotic surgery vs laparoscopic surgery in patients with diagnosis of endometriosis: a systematic review and meta-analysis. J Robot Surg 14(5):687–694. https://doi.org/10.1007/s11701-020-01061-y
doi: 10.1007/s11701-020-01061-y
pubmed: 32146573
Peters BS, Armijo PR, Krause C, Choudhury SA, Oleynikov D (2018) Review of emerging surgical robotic technology. Surg Endosc 32(4):1636–1655. https://doi.org/10.1007/s00464-018-6079-2
doi: 10.1007/s00464-018-6079-2
pubmed: 29442240
Gueli Alletti S, Chiantera V, Arcuri G, Gioè A, Oliva R, Monterossi G et al (2022) Introducing the new surgical robot HUGO™ RAS: system description and docking settings for gynecological surgery. Front Oncol 12:898060. https://doi.org/10.3389/fonc.2022.898060
doi: 10.3389/fonc.2022.898060
pubmed: 35756633
pmcid: 9218341
Monterossi G, Pedone Anchora L, Gueli Alletti S, Fagotti A, Fanfani F, Scambia G (2022) The first European gynaecological procedure with the new surgical robot Hugo
Panico G, Campagna G, Caramazza D, Vacca L, Mastrovito S, Ercoli A et al (2023) HUGO(TM) RAS System in urogynaecology: the first nerve sparing sacral colpopexy for pelvic organ prolapse. Facts Views Vis ObGyn 15(1):83–7. https://doi.org/10.52054/FVVO.15.1.054
Revised American Society for Reproductive Medicine classification of endometriosis: 1996 (1997) Fertil Steril 67(5):817–21. https://doi.org/10.1016/s0015-0282(97)81391-x
Johnson NP, Hummelshoj L, Adamson GD, Keckstein J, Taylor HS, Abrao MS et al (2017) World Endometriosis Society consensus on the classification of endometriosis. Hum Reprod 32(2):315–324. https://doi.org/10.1093/humrep/dew293
doi: 10.1093/humrep/dew293
pubmed: 27920089
Delgado DA, Lambert BS, Boutris N, McCulloch PC, Robbins AB, Moreno MR et al (2018) Validation of digital visual analog scale pain scoring with a traditional paper-based visual analog scale in adults. J Am Acad Orthop Surg Glob Res Rev 2(3):e088. https://doi.org/10.5435/JAAOSGlobal-D-17-00088
doi: 10.5435/JAAOSGlobal-D-17-00088
pubmed: 30211382
pmcid: 6132313
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(2):205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae
doi: 10.1097/01.sla.0000133083.54934.ae
pubmed: 15273542
pmcid: 1360123
Rosati A, Pavone M, Campolo F, De Cicco Nardone A, Raimondo D, Serracchioli R et al (2022) Surgical and functional impact of nerve-sparing radical hysterectomy for parametrial deep endometriosis: a single centre experience. Facts Views Vis ObGyn 14(2):121–7. https://doi.org/10.52054/FVVO.14.2.016
Ianieri MM, Raimondo D, Rosati A, Cocchi L, Trozzi R, Maletta M et al (2022) Impact of nerve-sparing posterolateral parametrial excision for deep infiltrating endometriosis on postoperative bowel, urinary, and sexual function. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet 159(1):152–159. https://doi.org/10.1002/ijgo.14089
doi: 10.1002/ijgo.14089
Ianieri MM, Nardone ADC, Pavone M, Benvenga G, Pafundi MP, Campolo F et al (2023) Are ureterolysis for deep endometriosis really all the same? An anatomical classification proposal for ureterolysis: a single-center experience. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. https://doi.org/10.1002/ijgo.14790
Raffaelli M, Gallucci P, Voloudakis N, Pennestrì F, De Cicco R, Arcuri G et al (2023) The new robotic platform Hugo™ RAS for lateral transabdominal adrenalectomy: a first world report of a series of five cases. Updates Surg 75(1):217–225. https://doi.org/10.1007/s13304-022-01410-6
doi: 10.1007/s13304-022-01410-6
pubmed: 36333563
Nezhat CR, Stevens A, Balassiano E, Soliemannjad R (2015) Robotic-assisted laparoscopy vs conventional laparoscopy for the treatment of advanced stage endometriosis. J Minim Invas Gynecol 22(1):40–44. https://doi.org/10.1016/j.jmig.2014.06.002
doi: 10.1016/j.jmig.2014.06.002
Soto E, Luu TH, Liu X, Magrina JF, Wasson MN, Einarsson JI et al (2017) Laparoscopy vs. robotic surgery for endometriosis (LAROSE): a multicenter, randomized, controlled trial. Fertil Steril 107(4):996–1002.e3. https://doi.org/10.1016/j.fertnstert.2016.12.033
Nezhat FR, Sirota I (2014) Perioperative outcomes of robotic assisted laparoscopic surgery versus conventional laparoscopy surgery for advanced-stage endometriosis. JSLS 18(4):e201400094. https://doi.org/10.4293/JSLS.2014.00094
Magrina JF, Espada M, Kho RM, Cetta R, Chang YHH, Magtibay PM (2015) Surgical excision of advanced endometriosis: perioperative outcomes and impacting factors. J Minim Invas Gynecol 22(6):944–950. https://doi.org/10.1016/j.jmig.2015.04.016
doi: 10.1016/j.jmig.2015.04.016
Fanfani F, Restaino S, Ercoli A, Chiantera V, Fagotti A, Gallotta V et al (2016) Robotic versus laparoscopic surgery in gynecology: which should we use? Minerva Ginecol 68(4):423–430
pubmed: 26633042
Ercoli A, Bassi E, Ferrari S, Surico D, Fagotti A, Fanfani F et al (2017) Robotic-assisted conservative excision of retrocervical-rectal deep infiltrating endometriosis: a case series. J Minim Invas Gynecol 24(5):863–868. https://doi.org/10.1016/j.jmig.2017.03.011
doi: 10.1016/j.jmig.2017.03.011
Ianieri MM, Della Corte L, Campolo F, Cosentino F, Catena U, Bifulco G et al (2021) Indocyanine green in the surgical management of endometriosis: a systematic review. Acta Obstet Gynecol Scand 100(2):189–199. https://doi.org/10.1002/ijgo.14790
doi: 10.1002/ijgo.14790
pubmed: 32895911
Pavone M, Marescaux J, Seeliger B (2023) Current status of robotic abdominopelvic surgery. Show-Chwan Med J 22(3):467–473. https://doi.org/10.30185/scmj.202307/pp.0003
doi: 10.30185/scmj.202307/pp.0003