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Surgery for severe endometriosis
Surgery for severe endometriosis






surgery for severe endometriosis

surgery for severe endometriosis

Robotic surgery is an intriguing addition to current surgical approaches in gynaecology. 10 A non-inferiority of robotic surgery in comparison to laparoscopic endometriosis surgery has been stated, 11 but not superiority. 5–7 9 Only one study had a postoperative quality of life follow-up up to 6 months with no significant differences between robotic and laparoscopic surgery.

#Surgery for severe endometriosis trial#

10 Most studies, except the randomised controlled trial (RCT) by Soto et al, 10 showed an increased operating time in the robotic group with no other significant differences in the intraoperative or postoperative outcomes. We were able to find five controlled studies comparing robotics with traditional laparoscopy in endometriosis surgery, 5–9 but only one with a randomised study plan. There is obvious lack of data in this respect. Proving benefits in comparison to laparoscopy, which is the gold standard of endometriosis surgery is, however, more difficult due to the already minimally invasive nature of laparoscopy. 2 Also, same-day discharge after robotic-assisted hysterectomy has been found feasible and safe. 3 As expected, robotic surgery has been shown to offer certain benefits in patient recovery in comparison to laparotomy, such as lower postoperative pain and morbidity as well as shorter hospital stay. This has not, however, been sufficiently proved in randomised controlled studies. 2 Robotic assistance offers a high-definition three-dimensional view and articulating instruments that may allow more precise dissection than conventional laparoscopy in the pelvic area. It has been suggested that endometriosis surgery is suitable, if not most suited, for robotic assistance due to the technically challenging operative circumstances. In the past decade, robotic surgery has gained popularity in benign operative gynaecology. A multidisciplinary team including gynaecologists, colorectal surgeons and urologists is also frequently required, creating a need for centralisation of endometriosis surgery to centres with sufficient competence and instrumentation. Therefore, endometriosis surgery requires advanced surgical techniques with deep, but tissue-sparing, pelvic dissection, often in very difficult surgical conditions with increased risks of complications. The main goal of endometriosis surgery is symptom relief by restoring organ anatomy and function with total excision of endometriotic tissue, keeping in mind that endometriosis is a benign condition and hence no unreasonable postoperative harm for the patient is accepted. Endometriosis induces abdominal cavity inflammation that predisposes to severe adhesion formation between gynaecological and surrounding organs. Most commonly these implants are located in the pelvic area, namely in bowel, rectovaginal septum, urinary organs and sacrouterine ligaments. 1 Deep endometriosis is defined as endometriotic implants that infiltrate the underlying organs more than 5 mm in depth. At worst, endometriosis is a chronic disease that causes severe pain symptoms from teenage years to menopause, impairing the quality of life and also fecundity markedly. For unknown reasons, endometrium-like cells are implanted outside the uterus, mainly in the abdominal cavity, responding to menstrual cycle with bleeding, thus causing pain. Endometriosis is a common gynaecological disease affecting around 10% of the fertile-aged female population.








Surgery for severe endometriosis