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 (TM) 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 (TM) 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.
Pavone, M., Seeliger, B., Alesi, M. V., Goglia, M., Marescaux, J., Scambia, G., Ianieri, M. M., Initial experience of robotically assisted endometriosis surgery with a novel robotic system: first case series in a tertiary care center, <<UPDATES IN SURGERY>>, 2024; 76 (1): N/A-N/A. [doi:10.1007/s13304-023-01724-z] [https://hdl.handle.net/10807/292258]
Initial experience of robotically assisted endometriosis surgery with a novel robotic system: first case series in a tertiary care center
Pavone, Matteo
Primo
;Alesi, Maria Vittoria;Scambia, Giovanni;
2024
Abstract
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 (TM) 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 (TM) 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.
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