TITLE:
Robotic Assisted Surgery for Endometriosis—“Is the Way Forward?”
AUTHORS:
Rooma Sinha, Madhumathi Sanjay, Rupa Bana, Fozia Jeelani, Samita Kumari
KEYWORDS:
Endometriosis, Advanced, Robotic Surgery, Laparoscopy, Deep Infiltrating Endometriosis, Hysterectomy, Recurrence
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.6 No.2,
February
5,
2016
ABSTRACT: Endometriosis is a chronic and progressive gynecologic disorder that affects
10% - 50% of women of reproductive age worldwide. Chronic pain and infertility are
the most debilitating problems associated with it requiring both medical and surgical
treatment. Laparoscopy is considered the gold standard for diagnosis and treatment.
However, a 10% rate of conversion to laparotomy has been reported when performed
by skilled laparoscopic surgeons and much higher in low volume less skilled surgeons.
To improve surgical outcomes, robotic assistance is the logical next step in performing
minimally invasive gynecological surgeries, especially in complex endometriosis
cases. Enhanced 3D visualization and 10× magnification
along with Endowrist instruments with seven degrees of freedom facilitates precise
and careful dissection. Firefly technology using ICG green dye can improve detection
of small and invisible lesions. Robotics is useful in deep infiltrating disease
manifesting as lesions deeper than the superficial tissues of rectovaginal septum,
vaginal fornix, pelvic sidewalls, parametrium, bowel or ureter and bladder. Trials
show no increase in surgical time, blood loss, or intra- or postoperative complications
and similar clinical outcome when robotics is compared with laparoscopy. At present,
it is more appropriate to compare it with laparotomy rather than laparoscopy. Robotics
can be used to manage recurrence of endometriosis after hysterectomy. Surgeons experienced
in conventional laparoscopy can utilize robotic platform for deep infiltrating endometriosis
for performing complex surgical dissection and achieving the surgical goals in mind
and reduce conversions to open surgery. Robotic assistance can bridge the gap in
performance of laparoscopic surgery in advanced endometriosis.