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Massimello F, Merlot B, Chanavaz-Lacheray I, Volodarsky-Perel A, Cela V, Kade S, Dennis T, Roman H. Robotic-assisted versus conventional laparoscopic management of deep endometriosis involving the sacral plexus and sciatic nerve: A comparative before and after study. Int J Gynaecol Obstet 2024. [PMID: 38923519 DOI: 10.1002/ijgo.15734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/23/2024] [Accepted: 06/01/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE To compare robotic-assisted laparoscopy (RAL) and laparoscopy (LPS) for intraoperative and postoperative outcomes, and functional results after a 6-month follow-up period among patients having undergone excision of deep endometriosis (DE) involving the sacral plexus (SP) and sciatic nerve (SN). METHODS A retrospective analysis of 100 patients included in our prospective database, who underwent surgical eradication of DE involving the SP and SN at our tertiary referral centre between September 2018 and June 2023. Patients were managed by LPS (n = 71) until 2021, and subsequently by RAL (n = 29). RESULTS Baseline symptoms and distribution of DE lesions were comparable in the two groups. Nerve dissection, nerve shaving, and intra-nerve dissection were performed in 55 (77.5%), 14 (19.7%), and 2 (5.6%) patients in the LPS group, respectively. Nerve dissection and nerve shaving were performed and in 24 (82.8%) and 5 (17.2%) patients in the RAL group, while no cases of intra-nerve dissection were observed (P = 0.434). Mean operative times were 183.71 ± 85.32 min and 177.41 ± 77.19 min, respectively (P = 0.734). There were no reported cases of conversion to open surgery. Intraoperative and early postoperative complications were comparable between the two groups. At 6 months follow up, we observed a significant reduction in sciatic pain in both the LPS group (39.1% vs 15.6%, P < 0.001) and RAL group (37.5% vs 25%, P = 0.001), with no differences in terms of outcomes (P = 0.1). CONCLUSION Both LPS and RAL result in significant long-term relief of symptoms associated with SP and SN endometriosis. Although surgeons found that RAL improved the quality of excision of these specific DE localizations, our study did not reveal significant advantages in terms of its outcomes.
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Affiliation(s)
- Francesca Massimello
- Institut Franco-Européen Multidisciplinaire d'Endométriose (IFEMEndo), Bordeaux, France
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Department of gynecology and Obstetrics, Santa Chiara Hospital, Trento, Italy
| | - Benjamin Merlot
- Institut Franco-Européen Multidisciplinaire d'Endométriose (IFEMEndo), Bordeaux, France
- Franco-European Multidisciplinary Institute of Endometriosis-Middle East Clinic, Burjeel Medical City, Abu Dhabi, UAE
| | - Isabella Chanavaz-Lacheray
- Institut Franco-Européen Multidisciplinaire d'Endométriose (IFEMEndo), Bordeaux, France
- Department of Gynecology and Obstetrics, CH, Evreux, France
| | - Alex Volodarsky-Perel
- Institut Franco-Européen Multidisciplinaire d'Endométriose (IFEMEndo), Bordeaux, France
- Sheba Medical Centre, Tel Aviv University, Ramat Gan, Israel
| | - Vito Cela
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sandesh Kade
- Franco-European Multidisciplinary Institute of Endometriosis-Middle East Clinic, Burjeel Medical City, Abu Dhabi, UAE
| | - Thomas Dennis
- Institut Franco-Européen Multidisciplinaire d'Endométriose (IFEMEndo), Bordeaux, France
| | - Horace Roman
- Institut Franco-Européen Multidisciplinaire d'Endométriose (IFEMEndo), Bordeaux, France
- Franco-European Multidisciplinary Institute of Endometriosis-Middle East Clinic, Burjeel Medical City, Abu Dhabi, UAE
- Department of Gynecology and Obstetrics, Medical University Aarhus, Aarhus, Denmark
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Roman H, Braund S, Hennetier C, Celhay O, Pasquier G, Kade S, Dennis T, Merlot B. Combined Cystoscopic-Abdominal Versus Abdominal-Only Route for Complete Excision of Large Deep Endometriosis Nodules Infiltrating the Supratrigonal Area of the Bladder: A Comparative Study. J Minim Invasive Gynecol 2024; 31:295-303. [PMID: 38244721 DOI: 10.1016/j.jmig.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 01/22/2024]
Abstract
STUDY OBJECTIVE Surgical excision of large deep endometriosis nodules infiltrating the bladder may be challenging, particularly when the nodule limits are close to the trigone and ureteral orifice. Bladder nodules have classically been approached abdominally. However, combining a cystoscopic with an abdominal approach may help to better identify the mucosal borders of the lesion to ensure complete excision without unnecessary resection of healthy bladder. This study aimed to compare classical excision of large bladder nodules by abdominal route with a combined cystoscopic-abdominal approach. DESIGN Retrospective comparative study on data prospectively recorded in a database. Patients were managed from September 2009 to June 2022. SETTING Two tertiary referral endometriosis centers. PATIENTS A total of 175 patients with deep endometriosis infiltrating the bladder more than 2 cm undergoing surgical excision of bladder nodules. INTERVENTIONS Excision of bladder nodules by either abdominal or combined cystoscopic-abdominal approaches. MEASUREMENTS AND MAIN RESULTS A total of 141 women (80.6%) were managed by abdominal route and 34 women (19.4%) underwent a combined cystoscopic-abdominal approach. In 99.4% of patients, the approach was minimally invasive. Patients with nodules requiring the combined approach had a lower American Fertility Society revised score and endometriosis stage and less associated digestive tract nodules, but larger bladder nodules. They were less frequently associated with colorectal resection and preventive stoma. Operative time was comparable. The rate of early postoperative complications was comparable (8.8% vs 22%), as were the rates of ureteral fistula (2.2% vs 2.9%), bladder fistula (2.2% vs 0), and vesicovaginal fistula (0.7% vs 2.9%). CONCLUSION In our opinion, the combined cystoscopic-abdominal approach is useful in patients with large bladder nodules with limits close to the trigone and ureteral orifice. These large deep bladder nodules seemed paradoxically associated to less nodules on the digestive tract, resulting in an overall comparable total operative time and complication rate.
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Affiliation(s)
- Horace Roman
- Franco-European Multidisciplinary Endometriosis Institute (Drs. Roman, Dennis, and Merlot), Clinique Tivoli-Ducos, Bordeaux, France; Department of Gynecology and Obstetrics, Aarhus University Hospital, Denmark (Dr. Roman); Franco-European Multidisciplinary Endometriosis Institute - Middle East Clinic, Burjeel Medical City, Abu Dhabi, UAE (Dr. Roman, Kade, and Dr. Merlot).
| | - Sophia Braund
- Expert Center in Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France (Drs. Braund and Hennetier)
| | - Clotilde Hennetier
- Expert Center in Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France (Drs. Braund and Hennetier)
| | - Olivier Celhay
- Department of Urology (Dr. Celhay), Clinique Tivoli-Ducos, Bordeaux, France
| | - Geoffroy Pasquier
- Department of Urology, Clinique Mathilde, Rouen, France (Dr. Pasquier)
| | - Sandesh Kade
- Franco-European Multidisciplinary Endometriosis Institute - Middle East Clinic, Burjeel Medical City, Abu Dhabi, UAE (Dr. Roman, Kade, and Dr. Merlot)
| | - Thomas Dennis
- Franco-European Multidisciplinary Endometriosis Institute (Drs. Roman, Dennis, and Merlot), Clinique Tivoli-Ducos, Bordeaux, France
| | - Benjamin Merlot
- Franco-European Multidisciplinary Endometriosis Institute (Drs. Roman, Dennis, and Merlot), Clinique Tivoli-Ducos, Bordeaux, France; Franco-European Multidisciplinary Endometriosis Institute - Middle East Clinic, Burjeel Medical City, Abu Dhabi, UAE (Dr. Roman, Kade, and Dr. Merlot)
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Ferrari FA, Youssef Y, Naem A, Ferrari F, Odicino F, Krentel H, Moawad G. Robotic surgery for deep-infiltrating endometriosis: is it time to take a step forward? Front Med (Lausanne) 2024; 11:1387036. [PMID: 38504917 PMCID: PMC10948538 DOI: 10.3389/fmed.2024.1387036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 03/21/2024] Open
Abstract
Endometriosis is a chronic debilitating disease that affects nearly 10% of women of the reproductive age. Although the treatment modalities of endometriosis are numerous, surgical excision of the endometriotic implants and nodules remains the sole cytoreductive approach. Laparoscopic excision of endometriosis was proven to be beneficial in improving the postoperative pain and fertility. Moreover, it was also proved to be safe and efficient in treating the visceral localization of deep endometriosis, such as urinary and colorectal endometriosis. More recently, robotic-assisted surgery gained attention in the field of endometriosis surgery. Although the robotic technology provides a 3D vision of the surgical field and 7-degree of freedom motion, the safety, efficacy, and cost-effectiveness of this approach are yet to be determined. With this paper, we aim to review the available evidence regarding the role of robotic surgery in the management of endometriosis along with the current practices in the field.
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Affiliation(s)
| | - Youssef Youssef
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynaecology-Maimonides Medical Center, Brooklyn, NY, United States
| | - Antoine Naem
- Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
- Department of Obstetrics, Gynecology, Gynecologic Oncology, and Senology, Bethesda Hospital Duisburg, Duisburg, Germany
| | - Federico Ferrari
- Department of Clinical and Experimental Sciences, Division of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Franco Odicino
- Department of Clinical and Experimental Sciences, Division of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Harald Krentel
- Department of Obstetrics, Gynecology, Gynecologic Oncology, and Senology, Bethesda Hospital Duisburg, Duisburg, Germany
| | - Gaby Moawad
- Department of Obstetrics and Gynecology, George Washington University, Washington, DC, United States
- The Center for Endometriosis and Advanced Pelvic Surgery, Washington, DC, United States
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Olsen RG, Hartwell D, Dalsgaard T, Madsen ME, Bjerrum F, Konge L, Røder A. First experience with the Hugo™ robot-assisted surgery system for endometriosis: A descriptive study. Acta Obstet Gynecol Scand 2024; 103:368-377. [PMID: 38031442 PMCID: PMC10823395 DOI: 10.1111/aogs.14727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION The Medtronic Hugo™ Robot-assisted Surgery (RAS) system was recently approved for clinical use. We explored the safety and feasibility of this system for endometriosis surgery. The primary outcome was safe case completion without major surgical complications (Clavien-Dindo grade ≤2) and no conversion to open surgery or laparoscopy. MATERIAL AND METHODS Surgeries for endometriosis performed at the Department of Gynecology, Rigshospitalet, on the Medtronic Hugo™ RAS system were included. Two experienced robotic surgeons performed all surgeries with their usual robotic team. The variables included were patient demographics, peri- and postoperative data, complications and 30-day readmission rate. We used the IDEAL framework 1/2a for surgical innovation in this descriptive study. RESULTS The first 12 patients were included. All cases were completed without intraoperative complications or conversion. Four patients experienced Clavien-Dindo grade 1 postoperative complications. No patients were re-admitted within 30 days. Median docking time (17 minutes), console time (87.5 minutes), blood loss (40 mL) and length of hospital stay (1 day) were acceptable compared with previous literature. CONCLUSIONS In this pilot study, we found the Medtronic Hugo™ RAS system safe and feasible for robot-assisted surgery for endometriosis. The advent of new robotic systems is welcomed to accelerate the development of technology that will advance surgical care for patients across the globe.
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Affiliation(s)
- Rikke Groth Olsen
- Copenhagen Academy for Medical Education and Simulation (CAMES)CopenhagenDenmark
- Copenhagen Prostate Cancer Center, Department of UrologyCopenhagen University Hospital‐RigshospitaletCopenhagenDenmark
- Department of GynecologyCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Dorthe Hartwell
- Department of GynecologyCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Torur Dalsgaard
- Department of GynecologyCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Mette Elkjær Madsen
- Department of GynecologyCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
- Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Flemming Bjerrum
- Copenhagen Academy for Medical Education and Simulation (CAMES)CopenhagenDenmark
- Department of Surgery, Herlev‐Gentofte HospitalHerlevDenmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES)CopenhagenDenmark
- Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Andreas Røder
- Copenhagen Prostate Cancer Center, Department of UrologyCopenhagen University Hospital‐RigshospitaletCopenhagenDenmark
- Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
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Hebert T. Robotic assisted laparoscopy for deep infiltrating endometriosis. Best Pract Res Clin Obstet Gynaecol 2024; 92:102422. [PMID: 38007964 DOI: 10.1016/j.bpobgyn.2023.102422] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 10/09/2023] [Accepted: 10/22/2023] [Indexed: 11/28/2023]
Abstract
Deep infiltrative endometriosis is a condition affecting up to 15 % of women of childbearing age, defined by extra uterine location of endometrial like tissues. The symptoms of endometriosis range from severe dysmenorrhea to infertility, chronic pelvic pain, bowel dysfunction and urinary tract involvement to name the most common. Endometriosis has an impact on the quality of life of patients, with personal and social consequences. Although medical treatment is indicated in the first instance, surgery may be necessary. Standard laparoscopy has become the gold standard for this surgery. However, surgery for deep infiltrative endometriosis is known to be highly complex, and the significant development of robotic assistance in recent years has had an impact on the evolution of surgical practice. This comprehensive review of the literature provides an overview of the contributions of robotic surgery in the field of endometriosis and gives an insight into the next steps in its development.
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Affiliation(s)
- T Hebert
- Centre Olympe de Gouges, Gynecologic Surgery Department, University Hospital, Tours, France.
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Rocha MA, Mendes G, Castro LF, Mesquita S, Teixeira BL, Madanelo M, Vital JA, Marques-Monteiro M, Vinagre N, Oliveira B, Magalhães M, Príncipe P, Ferreira H, Silva-Ramos M. Outcomes of Urinary Tract Endometriosis-Laparoscopic Treatment: A 10-Year Retrospective Study. J Clin Med 2023; 12:6996. [PMID: 38002610 PMCID: PMC10672564 DOI: 10.3390/jcm12226996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/29/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
INTRODUCTION Urinary tract endometriosis (UTE), a rare manifestation, encompasses bladder and ureteral involvement. Surgical intervention is commonly recommended for UTE, though the optimal surgical approach remains a subject of debate. This study aims to report our centre's experience with UTE. METHODS We conducted a retrospective cohort study of 55 patients who underwent surgical treatment for UTE at a single tertiary centre over a 10-year period (2012-2022). Patient data, including demographics, symptoms, intraoperative findings, and complications, were collected from medical records. Data were statistically analysed, and correlations were explored. RESULTS The study population had a mean age of 37.11 years, with dysmenorrhea (89.1%) being the most common symptom. Bladder endometriosis was present in 27 cases, ureteral endometriosis in 25, and mixed-location in 3. Laparoscopy was the primary surgical approach, with multidisciplinary teams involving urologists. There were six patients with postoperative complications, and there were six (10.9%) recurrences of endometriosis. A positive correlation was found between age and recurrence, but no significant predictors of recurrence were identified in our analysis. CONCLUSIONS Laparoscopic treatment of urinary endometriosis is safe and effective. Multidisciplinary collaboration plays a pivotal role in addressing this challenging condition.
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Affiliation(s)
- Maria Alexandra Rocha
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - Gonçalo Mendes
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - Luis Ferreira Castro
- Gynecology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (L.F.C.); (H.F.)
| | - Sofia Mesquita
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - Bernardo Lobão Teixeira
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - Mariana Madanelo
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - João Aragão Vital
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - Miguel Marques-Monteiro
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - Nuno Vinagre
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - Beatriz Oliveira
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - Martinha Magalhães
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - Paulo Príncipe
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - Hélder Ferreira
- Gynecology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (L.F.C.); (H.F.)
| | - Miguel Silva-Ramos
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
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Honde C, Agostini A, Pivano A, Piechon L, Courbiere B, Netter A. [Management of endometriomas in France: A survey of practices]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:408-414. [PMID: 37353080 DOI: 10.1016/j.gofs.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 04/02/2023] [Accepted: 06/17/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVES To present an overview of French practices for the management of endometriomas. METHODS We carried out a nationwide survey of practices concerning the management of endometriomas between October 2021 and January 2022. This study was carried out by means of two questionnaires sent to surgical centers used to treat endometriosis (n=62) and to Assisted Reproductive Technology (ART) centers (n=102). RESULTS At the end of the survey, 39/62 (62.9%) surgical teams from the centers contacted had given a response and 51/102 (50.0%) from ART centers. Laparoscopic cystectomy was the technique most frequently used by almost two thirds of the surgical teams (61%) when there was no known infertility, whereas it was the most common technique for only 14% of the ART teams. On the contrary, ultrasound-guided sclerotherapy was the most frequent technique for more than half of the ART teams (56%) and for only 8% of the surgical teams. In case of recurrence, 49% of surgical teams would choose ultrasound-guided sclerotherapy. Prior to IVF, 73% of ARP teams stated that they 'rarely' treated endometriomas. CONCLUSION The results of our study show a certain variability in practices between different centers and depending on the presence or absence of infertility for the management of endometriomas in France.
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Affiliation(s)
- C Honde
- Department of Gynecology and Obstetrics, AP-HM, Assistance publique-Hôpitaux de Marseille, Marseille, France
| | - A Agostini
- Department of Gynecology and Obstetrics, AP-HM, Assistance publique-Hôpitaux de Marseille, Marseille, France
| | - A Pivano
- Department of Gynecology and Obstetrics, AP-HM, Assistance publique-Hôpitaux de Marseille, Marseille, France
| | - L Piechon
- Department of Gynecology and Obstetrics, AP-HM, Assistance publique-Hôpitaux de Marseille, Marseille, France
| | - B Courbiere
- Department of Gynecology and Obstetrics, AP-HM, Assistance publique-Hôpitaux de Marseille, Marseille, France; Institut méditerranéen de biodiversité et d'écologie marine et continentale (IMBE), Aix Marseille University, CNRS, IRD, Avignon University, Marseille, France
| | - A Netter
- Department of Gynecology and Obstetrics, AP-HM, Assistance publique-Hôpitaux de Marseille, Marseille, France; Institut méditerranéen de biodiversité et d'écologie marine et continentale (IMBE), Aix Marseille University, CNRS, IRD, Avignon University, Marseille, France.
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Oliveira MAP, Raymundo TS, Pereira TD, de Souza RJ, Lima FV, De Wilde RL, Brollo LC. Robotic Surgery for Bladder Endometriosis: A Systematic Review and Approach. J Clin Med 2023; 12:5416. [PMID: 37629459 PMCID: PMC10455656 DOI: 10.3390/jcm12165416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/01/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
INTRODUCTION Women with bladder endometriosis often present with more advanced stages of endometriosis. Robotic surgery has emerged as a promising approach to the management of bladder endometriosis. This systematic review aims to analyze the current literature on robotic surgery for bladder endometriosis and describe our systematic approach to surgical treatment. METHODS This review followed the PRISMA guidelines, which ensured a comprehensive and transparent approach to selecting and evaluating relevant studies. We conducted a thorough literature search to identify studies that investigated the use of robotic surgery for bladder endometriosis. Relevant databases were searched, and inclusion and exclusion criteria were applied to select eligible studies. Data extraction and analysis were performed to assess the outcomes and effectiveness of robotic surgery for the treatment of bladder endometriosis. RESULTS We did not find any randomized clinical trials with the use of robotics in the treatment of bladder endometriosis. We found only two retrospective studies comparing robotic surgery with laparoscopy, and another retrospective study comparing robotic surgery, laparoscopy, and laparotomy in the treatment of bladder endometriosis. All the other 12 studies were solely case reports. Despite the lack of robust evidence in the literature, the studies demonstrated that robotic surgery is feasible and is associated with reduced postoperative pain, shorter hospital stays, and faster recovery. CONCLUSIONS The utilization of robotic technology is a promising option for the surgical management of bladder endometriosis. We advocate a surgical systematic approach for the robotic treatment of bladder endometriosis. Robotic technology, with its 3D vision, instrumental degrees of freedom, and precision, particularly in suturing, may provide potential benefits over traditional laparoscopy.
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Affiliation(s)
- Marco Aurelio Pinho Oliveira
- Department of Gynecology, State University of Rio de Janeiro, Rio de Janeiro 20551-030, Brazil; (T.S.R.); (T.D.P.); (R.J.d.S.); (L.C.B.)
| | - Thiers Soares Raymundo
- Department of Gynecology, State University of Rio de Janeiro, Rio de Janeiro 20551-030, Brazil; (T.S.R.); (T.D.P.); (R.J.d.S.); (L.C.B.)
- Department of Gynecology, Cardoso Fontes Federal Hospital, Rio de Janeiro 22745-130, Brazil
| | - Thiago Dantas Pereira
- Department of Gynecology, State University of Rio de Janeiro, Rio de Janeiro 20551-030, Brazil; (T.S.R.); (T.D.P.); (R.J.d.S.); (L.C.B.)
| | - Ricardo José de Souza
- Department of Gynecology, State University of Rio de Janeiro, Rio de Janeiro 20551-030, Brazil; (T.S.R.); (T.D.P.); (R.J.d.S.); (L.C.B.)
| | - Felipe Vaz Lima
- Department of Urology, Gaffrée e Guinle University Hospital, Rio de Janeiro 20270-004, Brazil;
| | - Rudy Leon De Wilde
- Department of Gynecology, University Hospital for Gynecology, Pius Hospital, 26121 Oldenburg, Germany;
| | - Leila Cristina Brollo
- Department of Gynecology, State University of Rio de Janeiro, Rio de Janeiro 20551-030, Brazil; (T.S.R.); (T.D.P.); (R.J.d.S.); (L.C.B.)
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Legendri S, Carbonnel M, Feki A, Moawad G, Aubry G, Vallée A, Ayoubi JM. Improvement of Post-Operative Quality of Life in Patients 2 Years after Minimally Invasive Surgery for Pain and Deep Infiltrating Endometriosis. J Clin Med 2022; 11:jcm11206132. [PMID: 36294462 PMCID: PMC9605320 DOI: 10.3390/jcm11206132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/04/2022] [Accepted: 10/13/2022] [Indexed: 11/18/2022] Open
Abstract
This study addressed the improvement in the quality of life of patients 2 years after minimally invasive surgery for painful deep infiltrating endometriosis (DIE), evaluated with EHP-5 (Endometriosis Health Profile-5) scores and the intensity of dysmenorrhea and dyspareunia. This was a retrospective study, performed in a referral centre for endometriosis, between January 2010 and January 2019. EHP-5 scores were complete for 54 patients, and two subgroups were analysed: classic laparoscopy (CL) vs. robotic laparoscopy (RL), and conservative surgery (ConservS) vs. total surgery (TS). There was an important decrease in 2-year post-operative EHP-5 scores in the global population (pre-op: 61.36 (42.18−68.75) and 2-year post-op: 20.45 (0−38.06); p < 0.001). The Visual Analogic Scale (VAS) was also lower for dysmenorrhea (pre-op: 8 (7−9.75) vs. 2-year post-op: 3 (2−5.25); p < 0.001) and dyspareunia (pre-op: 6 (3.1−8.9) vs. 2-year post-op: 3 (0−6); p < 0.001). In the subgroup analysis, EHP-5 scores were improved in the RL group (pre-op: 65.9 (59.09−71.02) vs. 2-year post-op: 11.4 (0−38.06); p < 0.001) and the CL group (pre-op: 50 (34.65−68.18) vs. 2-year post-op: 27.27 (14.20−40.90); p < 0.001), with a slight advantage for RL (p = 0.04), and the same improvements were found for ConservS (pre-op: 61.4 (38.06−71.59) vs. 2-year post-op: 22.7 (11.93−38.07); p < 0.001) and TS groups (pre-op: 61.59 (51.70−68.75) vs. 2-year post-op: 13.63 (0−44.30); p < 0.001). Minimally invasive surgery improved the quality of life for DIE patients 2 years after surgery, and conservative surgery showed comparable results to total surgery.
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Affiliation(s)
- Sophie Legendri
- Department of Obstetrics and Gynecology, Foch Hospital, 40 Rue Worth, 92150 Suresnes, France
- Medical School, University of Versailles, Saint-Quentin-en-Yvelines, 55 Avenue de Paris, 78000 Versailles, France
| | - Marie Carbonnel
- Department of Obstetrics and Gynecology, Foch Hospital, 40 Rue Worth, 92150 Suresnes, France
- Medical School, University of Versailles, Saint-Quentin-en-Yvelines, 55 Avenue de Paris, 78000 Versailles, France
- Correspondence:
| | - Anis Feki
- Department of Obstetrics and Gynecology, Cantonal Hospital Fribourg, 1702 Fribourg, Switzerland
| | - Gaby Moawad
- Department of Obstetrics and Gynecology, The George Washington University Hospital, Washington, DC 20037, USA
| | - Gabrielle Aubry
- Department of Obstetrics and Gynecology, Foch Hospital, 40 Rue Worth, 92150 Suresnes, France
| | - Alexandre Vallée
- Department of Clinical Research and Innovation, Foch Hospital, 40 Rue Worth, 92150 Suresnes, France
| | - Jean-Marc Ayoubi
- Department of Obstetrics and Gynecology, Foch Hospital, 40 Rue Worth, 92150 Suresnes, France
- Medical School, University of Versailles, Saint-Quentin-en-Yvelines, 55 Avenue de Paris, 78000 Versailles, France
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Andres MP, Souza C, Villaescusa M, Vieira M, Abrao MS. The current role of robotic surgery in endometriosis management. Expert Rev Endocrinol Metab 2022; 17:63-73. [PMID: 35073819 DOI: 10.1080/17446651.2022.2031976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Endometriosis is a chronic inflammatory disease that affects approximately 10%-15% of women of childbearing age. Laparoscopic surgery is the preferred surgical approach. Recently, robotic surgery has been used for benign gynecologic surgery, but its role in the treatment of endometriosis is still unknown. AREAS COVERED We included studies that evaluated the outcomes of robotic surgery for endometriosis. Using the keywords 'endometriosis' and 'robotics', a comprehensive literature search on PubMed, Embase, and the Cochrane Library was performed in July 2021. EXPERT OPINION Robotic surgery for endometriosis has similar outcomes as conventional laparoscopy, with no evidence of increased complication rates. Despite the non-inferiority of the surgical route, the associated costs of robotic surgery limit its availability. Rapid development of robot-assisted surgery necessitates long-term prospective randomized controlled trials. However, the limitations of robotic surgery should not be overlooked. If robotic surgery can facilitate the spread of minimally invasive surgery, it will be necessary to evaluate the cost, availability, complexity of the lesions, and most importantly, the results of patient satisfaction and values of value-based medicine.
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Affiliation(s)
- Marina Paula Andres
- Departamento de Obstetricia E Ginecologia, Hospital Das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Division of Gynecologic, BP - A Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Carolina Souza
- Division of Gynecologic, BP - A Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Marina Villaescusa
- Division of Gynecologic, BP - A Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Marcelo Vieira
- Gynecologic Oncology, Barretos Cancer Hospital/Pio XII Foundation, Barretos, São Paulo, Brazil
| | - Mauricio S Abrao
- Departamento de Obstetricia E Ginecologia, Hospital Das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Division of Gynecologic, BP - A Beneficência Portuguesa de São Paulo, São Paulo, Brazil
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Donval L, Niro J, Gaillard T, Amari S, Chis C, Poupon C, Gauthier A, Panel P. Nomogram for predicting a complex ureteral procedure in pelvic endometriosis surgery. J Minim Invasive Gynecol 2022; 29:656-664. [DOI: 10.1016/j.jmig.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 11/30/2022]
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