Robotic surgery for bowel endometriosis: a multidisciplinary management of a complex entity

Abstract

Abstract Background Bowel endometriosis impacts quality of life. Treatment requires complex surgical procedures with associated morbidity. Precision approach with robotic surgery leads to organ preservation. Bowel endometriosis requires a multidisciplinary management to improve patient outcomes. This study evaluates perioperative outcomes of bowel endometriosis undergoing multidisciplinary planning and robotic surgery. Methods Consecutive cases of multidisciplinary robotic bowel endometriosis procedures (January 2021–December 2022) were evaluated from a prospectively maintained database in a national endometriosis accredited centre. Patients were managed through a multidisciplinary setting including gynaecologists, colorectal robotic surgeons, and other specialists. Dyschezia (menstrual and non-cyclical) and quality of life were assessed pre- and postoperatively (6 months) through validated questionnaires. Results Sixty-eight consecutive cases of robotic bowel endometriosis were included. Median age was 35.0 (30.2–42.0) years. Median body mass index was 24.0 (21.0–26.7) kg/m2. Procedures performed were 48 (70.6%) shavings, 11 (16.2%) deep shavings, 3 (4.4%) disc excisions, and 6 (8.8%) segmental resections. One (1.5%) patient required temporary stoma. Median operating time was 150 (120–180) min. There were no conversions/return to theatre postoperatively. Median endometriotic nodule size was 25.0 (15.5–40.0) mm. Two (2.9%) patients developed postoperative complications. Median length of postoperative stay was 2 (2–4) days. Median follow-up was 12 (7–17) months. One (1.5%) patient recurred. Median menstrual dyschezia score improved from 5.0 (2.0–8.0) to 1.0 (0.0–5.7). Median non-cyclical dyschezia significantly improved (p < 0.001) from 1.0 (0.0–5.7) to 0.0 (0.0–2.0). Median quality of life score improved from 52.5 (35.0–70.0) to 74.5 (60.0–80.0). Conclusions Robotic multidisciplinary approach to bowel endometriosis provides good perioperative outcomes with improvement of dyschezia and quality of life.