Comparison of robotic versus conventional laparoscopy for the treatment of colorectal endometriosis: Pilot study of an expert center

Marjolaine Le Gac; Clément Ferrier; Cyril Touboul; Clémentine Owen; Alexandra Arfi; Anne-Sophie Boudy; Aude Jayot; Sofiane Bendifallah; Emile Daraï

doi:10.1016/j.jogoh.2020.101885

Comparison of robotic versus conventional laparoscopy for the treatment of colorectal endometriosis: Pilot study of an expert center

J Gynecol Obstet Hum Reprod. 2020 Jul 29:101885. doi: 10.1016/j.jogoh.2020.101885. Online ahead of print.

Authors

Marjolaine Le Gac¹, Clément Ferrier¹, Cyril Touboul², Clémentine Owen¹, Alexandra Arfi¹, Anne-Sophie Boudy¹, Aude Jayot¹, Sofiane Bendifallah², Emile Daraï³

Affiliations

¹ Department of Gynecology-Obstetrics and Medicine of Reproduction, Hôpital Tenon, Sorbonne University, Assistance Publique des Hôpitaux de Paris, France.
² Department of Gynecology-Obstetrics and Medicine of Reproduction, Hôpital Tenon, Sorbonne University, Assistance Publique des Hôpitaux de Paris, France; Groupe de Recherche Clinique in endometriosis (GRC-6 Sorbonne University), Centre Expert En Endometriose (C3E), France; UMRS-938 Sorbonne University, France.
³ Department of Gynecology-Obstetrics and Medicine of Reproduction, Hôpital Tenon, Sorbonne University, Assistance Publique des Hôpitaux de Paris, France; Groupe de Recherche Clinique in endometriosis (GRC-6 Sorbonne University), Centre Expert En Endometriose (C3E), France; UMRS-938 Sorbonne University, France. Electronic address: emile.darai@aphp.fr.

PMID: 32738498
DOI: 10.1016/j.jogoh.2020.101885

Abstract

Introduction: Surgical management of deep endometriosis with colorectal involvement remains an option after failure of medical treatments. Conventional laparoscopy is currently considered the standard approach for surgical treatment. Recently, assisted-robotic laparoscopy emerged as an alternative to conventional laparoscopy but with low evidence.

Methods: From March 2019 to September 2019, we conducted a prospective cohort study of 48 patients undergoing a surgical treatment for colorectal endometriosis (rectal shaving, discoid excision or segmental resection). The interventions were either performed by robotic or conventional laparoscopy. Patients' characteristics, operative and post-operative data were compared between the robotic and the conventional laparoscopic group.

Results: 48 patients were included, 25 in the conventional laparoscopy group and 23 in the robotic group. Patients' characteristics and operative findings were similar between the two groups, except for a trend in a higher incidence of associated surgical urinary or digestive procedures in the robotic group (p = 0.06). The mean total surgical room occupancy time and operating time were longer in the in the robotic group (281 ± 97 min vs 208 ± 85 min; p = 0.008) and (221 ± 94 min vs 163 ± 83 min (p = 0.03), respectively. The mean intra operative blood loss, the incidence of intra operative, post-operative complication (according to Clavien-Dindo classification) rates and voiding dysfunction were similar in the two groups. The rate of grade III complication was higher in the robotic group (13 % vs 0%) without reaching a significance (p = 0.17). The mean hospital stay was 8 ± 4.4 days in the robotic group and 6.5 ± 2.6 days in the conventional laparoscopy group (p = 0.18).

Conclusion: Despite our initial experience in robotic surgery, our results support that robotic surgery is an adequate alternative to conventional laparoscopy for endometriosis colorectal resection.

Keywords: Colorectal endometriosis; Endometriosis; Laparoscopy; Robotic surgical procedures.