Peri-operative outcomes of patients with stage IV endometriosis undergoing robotic-assisted laparoscopic surgery Article

International Collaboration

cited authors

  • Brudie, Lorna A., Gaia, Giorgia, Ahmad, Sarfraz, Finkler, Neil J., Bigsby, Glenn E., Ghurani, Giselle B., Kendrick, James E., Rakowski, Joseph A., Groton, Jessica H., Holloway, Robert W.

abstract

  • We analyzed peri-operative outcomes of 80 patients who underwent robotic-assisted laparoscopic surgery and were diagnosed with stage IV endometriosis (revised American Society for Reproductive Medicine) between January 2007 and December 2010 at a tertiary gynecologic oncology referral center with a fellowship training program. Eligible women had a combination of one or more factors: pelvic mass, sub-acute or chronic pelvic pain, dysmenorrhea, dyspareunia, elevated serum CA-125, diagnosed with stage IV endometriosis at surgery with robotic-assisted gynecologic procedures using the da Vinci (R) Surgical System. The mean age was 43.7 +/- 7.0 years, body mass index 27.5 +/- 7.4 kg/m(2), and 23 (28.9%) patients had prior endometriosis surgery. Presenting symptoms included: chronic pelvic pain (48.8%), dysmenorrhea (40.3%), and dyspareunia (33.8%). Sixtynine (86%) patients had pelvic masses (43 unilateral and 26 bilateral). Thirty-seven (46.3%) had elevated CA-125 levels (mean 97.9 +/- 71.6 U/ml). Forty-eight (60%) underwent robotic-assisted laparoscopic hysterectomy (RALH)/bilateral salpingo-oophorectomy (BSO), 9 (11.3%) RALH/unilateral salpingo-oophorectomy (USO), 5 (6.3%) modified radical hysterectomy, and 10 (13%) USO or BSO only. Four (5%) had ovarian cystectomies with excision of endometriotic implants. Three (3.8%) underwent appendectomy and no patient required bowel resection. Four (5%) patients required conversion to laparotomy during the first 15 cases of this series [dense adhesions (3) and ureteral injury (1)]. Mean operative time was 115 +/- 46 min, blood loss 88 +/- 67 ml, and length of stay 1.0 +/- 0.4 days. There were four (5%) complications (ureteral injury, cuff abscess, cuff hematoma, re-admission for nausea and vomiting secondary to narcotics) and no transfusions. One (1.3%) patient underwent a second surgery for pain (dyspareunia). Robotic-assisted surgery for stage IV endometriosis resulted in excellent pain relief, with few laparotomy conversions or complications during a robotic learning-curve experience.

authors

Publication Date

  • December 1, 2012

webpage

published in

category

  • SURGERY  Web of Science Category

start page

  • 317

end page

  • 322

volume

  • 6

issue

  • 4

WoS Citations

  • 8

WoS References

  • 26