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Robotic surgery for bowel endometriosis: a multidisciplinary management of a complex entity
Techniques in Coloproctology ( IF 2.7 ) Pub Date : 2024-02-08 , DOI: 10.1007/s10151-023-02904-0
G N Piozzi 1 , V Burea 2 , R Duhoky 1 , S Stefan 1 , C So 2 , D Wilby 2, 3 , D Tsepov 2 , J S Khan 1, 2, 4
Affiliation  

Background

Bowel endometriosis impacts quality of life. Treatment requires complex surgical procedures with associated morbidity. Precision approach with robotic surgery leads to organ preservation. Bowel endometriosis requires a multidisciplinary management to improve patient outcomes. This study evaluates perioperative outcomes of bowel endometriosis undergoing multidisciplinary planning and robotic surgery.

Methods

Consecutive cases of multidisciplinary robotic bowel endometriosis procedures (January 2021–December 2022) were evaluated from a prospectively maintained database in a national endometriosis accredited centre. Patients were managed through a multidisciplinary setting including gynaecologists, colorectal robotic surgeons, and other specialists. Dyschezia (menstrual and non-cyclical) and quality of life were assessed pre- and postoperatively (6 months) through validated questionnaires.

Results

Sixty-eight consecutive cases of robotic bowel endometriosis were included. Median age was 35.0 (30.2–42.0) years. Median body mass index was 24.0 (21.0–26.7) kg/m2. Procedures performed were 48 (70.6%) shavings, 11 (16.2%) deep shavings, 3 (4.4%) disc excisions, and 6 (8.8%) segmental resections. One (1.5%) patient required temporary stoma. Median operating time was 150 (120–180) min. There were no conversions/return to theatre postoperatively. Median endometriotic nodule size was 25.0 (15.5–40.0) mm. Two (2.9%) patients developed postoperative complications. Median length of postoperative stay was 2 (2–4) days. Median follow-up was 12 (7–17) months. One (1.5%) patient recurred. Median menstrual dyschezia score improved from 5.0 (2.0–8.0) to 1.0 (0.0–5.7). Median non-cyclical dyschezia significantly improved (p < 0.001) from 1.0 (0.0–5.7) to 0.0 (0.0–2.0). Median quality of life score improved from 52.5 (35.0–70.0) to 74.5 (60.0–80.0).

Conclusions

Robotic multidisciplinary approach to bowel endometriosis provides good perioperative outcomes with improvement of dyschezia and quality of life.



中文翻译:


机器人手术治疗肠子宫内膜异位症:复杂实体的多学科管理


 背景


肠子宫内膜异位症会影响生活质量。治疗需要复杂的外科手术,并伴有并发症。机器人手术的精确方法可保留器官。肠子宫内膜异位症需要多学科管理以改善患者预后。本研究评估了接受多学科规划和机器人手术的肠子宫内膜异位症围手术期结局。

 方法


从国家子宫内膜异位症认证中心的前瞻性维护数据库中评估了多学科机器人肠子宫内膜异位症手术的连续病例(2021 年 1 月至 2022 年 12 月)。患者通过多学科环境进行管理,包括妇科医生、结直肠机器人外科医生和其他专家。通过经过验证的问卷在术前和术后 (6 个月) 评估排便困难 (月经和非周期性) 和生活质量。

 结果


纳入 68 例连续的机器人肠子宫内膜异位症病例。中位年龄为 35.0 (30.2-42.0) 岁。体重指数中位数为 24.0 (21.0–26.7) kg/m2。进行的手术是 48 例 (70.6%) 刨花、11 例 (16.2%) 深屑、3 例 (4.4%) 椎间盘切除术和 6 例 (8.8%) 节段切除术。1 例 (1.5%) 患者需要临时造口。中位手术时间为 150 (120-180) 分钟。术后没有转位/重返手术室。中位子宫内膜异位结节大小为 25.0 (15.5–40.0) mm。两名 (2.9%) 患者出现术后并发症。术后中位住院时间为 2 (2-4) 天。中位随访时间为 12 (7-17) 个月。1 例 (1.5%) 患者复发。中位月经困难评分从 5.0 (2.0-8.0) 提高到 1.0 (0.0-5.7)。中位非周期性排便困难从 1.0 (0.0-5.7) 显著改善 (p < 0.001) 到 0.0 (0.0-2.0)。生活质量评分中位数从 52.5 (35.0-70.0) 提高到 74.5 (60.0-80.0)。

 结论


机器人多学科方法治疗肠子宫内膜异位症可提供良好的围手术期结局,改善排便困难和生活质量。

更新日期:2024-02-08
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