Abstract

Background

Aim of the study was to present the surgical techniques and the postoperative outcomes in women treated with robotic excision for deep endometriosis involving the urinary tract.

Materials and methods

We retrospectively reviewed the prospectively recorded clinical data of women consecutively undergoing minimally invasive treatment for complex endometriosis involving urinary tract in our center between January 2012 and June 2018. All the patients received a preoperative multidisciplinary evaluation with the general surgeon, the gynecologist and the urologist due to the frequent concomitant involvement of bowel and genital system. Patients undergoing robotic surgery were treated with the Si or Xi da Vinci surgical system.

Results

A total of 74 consecutive patients were enrolled. Twenty-eight (37.8%) patients underwent conventional laparoscopy and 46 (62.2%) robotic surgery. Only patients treated with robotic approach were considered for the final analyses. Overall, 17 (36.9%) patients were treated with partial cystectomy, 13 (28.3%) with ureteral reimplantation, 10 (21.7%) patients were treated with ureteral lysis, 4 (8.7%) with removal of bladder endometrial node without opening the mucosa layer and 2 (4.3%) with ureteral end-to-end anastomosis. Concomitant involvement of bowel and genital system was registered in 14 (30.4%) and 32 (69.5%) patients, respectively. No conversions to laparotomy were recorded. Overall, 5 (10.9%) patients experienced postoperative complications, of which only one was a major complication (Clavien 3b). At a median follow-up of 31.3 (IQR 17.6–43.3) months, 4 (8.7%) patients experienced disease recurrence at the level of urinary tract.

Conclusions

Robotic excision of urological endometriosis represents a safe and effective treatment option, since a limited rate of surgical complications was recorded even in cases of multi-organ disease.

中文翻译：

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尿路子宫内膜异位症的机器人治疗：大容量单机构队列研究的初步结果和手术细节。

摘要

背景

该研究的目的是介绍接受机器人切除术治疗累及泌尿道的深部子宫内膜异位症的女性的手术技术和术后结果。

材料和方法

我们回顾性回顾了 2012 年 1 月至 2018 年 6 月期间在我中心连续接受微创治疗累及泌尿道的复杂子宫内膜异位症患者的临床资料。所有患者均接受了普外科医生、妇科医生和泌尿科医生的术前多学科评估。肠道和生殖系统经常同时受累。接受机器人手术的患者使用 Si 或 Xi da Vinci 手术系统进行治疗。

结果

总共招募了 74 名连续患者。28 名 (37.8%) 患者接受了常规腹腔镜检查，46 名 (62.2%) 患者接受了机器人手术。只有接受机器人方法治疗的患者才被考虑用于最终分析。总体而言，17 名 (36.9%) 患者接受了部分膀胱切除术，13 名 (28.3%) 患者接受了输尿管再植术，10 名 (21.7%) 患者接受了输尿管溶解术治疗，4 名 (8.7%) 患者接受了膀胱子宫内膜结节切除术而不打开粘膜层和 2 (4.3%) 输尿管端端吻合。分别有 14 名 (30.4%) 和 32 名 (69.5%) 患者同时伴有肠道和生殖系统受累。没有转为剖腹手术的记录。总体而言，5 名 (10.9%) 患者出现术后并发症，其中只有一名患者是主要并发症 (Clavien 3b)。中位随访为 31.3（IQR 17.6–43。

结论

泌尿系统子宫内膜异位症的机器人切除术是一种安全有效的治疗选择，因为即使在多器官疾病的情况下，手术并发症的发生率也很有限。