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Robertson J, Abbott J, Corbett-Burns S, Bukhari M, Perera S, Kalantan A, Sarofim M, Chou R, Cario G, Rosen D, Choi S, Wynn-Williams M, Condous G, Chou D. Treatment of rectosigmoid endometriosis by laparoscopic reverse submucosal dissection (LRSD): The Sydney partial thickness discoid excision technique. Aust N Z J Obstet Gynaecol 2024; 64:147-153. [PMID: 37905841 DOI: 10.1111/ajo.13762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/09/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Laparoscopic reverse submucosal dissection (LRSD) is a standardised surgical technique for removal of rectosigmoid endometriosis which optimises the anatomical dissection plane for excision of endometriotic nodules. AIM This cohort study assesses the outcomes of the first cohort of women treated by LRSD, for deeply infiltrating rectosigmoid endometriosis. MATERIALS AND METHODS Primary outcomes assessed were complication rate as defined by the Clavien-Dindo system, and completion of the planned LRSD. Secondary outcomes include mucosal breach, specimen margin involvement, length of hospital admission, and a comparison of pre-operative and post-operative pain, bowel function and quality of life surveys. These included the Endometriosis Health Profile Questionnaire (EHP-30), the Knowles-Eccersley-Scott Symptom Questionnaire (KESS) and the Wexner scale. RESULTS Of 19 patients treated, one required a segmental resection. The median length of hospital admission was two days (range 1-5) and no post-operative complications occurred. Median pain visual analogue scales (scale 0-10) were higher prior to surgery (dysmenorrhoea 9.0, dyspareunia 7.5, dyschezia 9.0, pelvic pain 6.0) compared to post-surgical median scores (dysmenorrhoea 5.0, dyspareunia 4.0, dyschezia 2.0, pelvic pain 4.0) at a median of six months (range 4-32). Quality of life studies suggested improvement following surgery with pre-operative median EHP-30 and KESS scores (EHP-30: 85 (5-106), KESS score 9 (0-20)) higher than post-operative scores (EHP-30: 48.5 (0-80), KESS score: 3 (0-19)). CONCLUSION This series highlights the feasibility of LRSD with low associated morbidity as a progression of partial thickness discoid excision (rectal shaving) for the treatment of rectosigmoid deep infiltrating endometriosis.
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Affiliation(s)
- Jessica Robertson
- Sydney Women's Endosurgery Centre, Sydney, New South Wales, Australia
| | - Jason Abbott
- Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW, Sydney, New South Wales, Australia
| | | | - Mujahid Bukhari
- Sydney Women's Endosurgery Centre, Sydney, New South Wales, Australia
| | - Shevy Perera
- Sydney Colorectal Associates, Sydney, New South Wales, Australia
| | - Assem Kalantan
- Sydney Women's Endosurgery Centre, Sydney, New South Wales, Australia
| | - Mikhail Sarofim
- Sydney Women's Endosurgery Centre, Sydney, New South Wales, Australia
| | - Rebecca Chou
- Liverpool Hospital, Sydney, New South Wales, Australia
| | - Greg Cario
- Sydney Women's Endosurgery Centre, Sydney, New South Wales, Australia
| | - David Rosen
- Sydney Women's Endosurgery Centre, Sydney, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW, Sydney, New South Wales, Australia
| | - Sarah Choi
- Sydney Women's Endosurgery Centre, Sydney, New South Wales, Australia
| | | | - George Condous
- OMNI Ultrasound and Gynaecological Care, Sydney, New South Wales, Australia
| | - Danny Chou
- Sydney Women's Endosurgery Centre, Sydney, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW, Sydney, New South Wales, Australia
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Crestani A, Le Gac M, de Labrouhe É, Touboul C, Bendifallah S, Ferrier C, Dabi Y, Darai E. Outcomes of discoid excision and segmental resection for colorectal endometriosis: robotic versus conventional laparoscopy. J Robot Surg 2024; 18:87. [PMID: 38386205 DOI: 10.1007/s11701-024-01854-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/28/2024] [Indexed: 02/23/2024]
Abstract
Surgery for deep endometriosis with colorectal involvement is an option after medical treatment failure. Over the past decade, robotic laparoscopy has emerged as an alternative to conventional laparoscopy. We aimed to evaluate surgical outcomes of robotic versus conventional laparoscopy for discoid excision and segmental resection. From 2019 to 2023, we conducted a retrospective cohort study of 152 consecutive patients with colorectal endometriosis who underwent robotic or conventional laparoscopy for discoid excision and colorectal resection. Ninety of the patients 152 underwent robotic surgery and 62 conventional laparoscopy. The mean total surgical room occupancy and operating times were longer in the robotic group: 270 ± 81 min vs 240 ± 79 min, p = 0.010, and 216 ± 78 min vs 190 ± 76, p = 0.027, respectively. The mean intraoperative blood loss, and the incidence of intra- and postoperative complications (according to Clavien-Dindo classification) were similar in the two groups. The mean hospital stay was greater after conventional laparoscopy (8 ± 5 vs 7 ± 4 days; p = 0.03), and the rate of persistent voiding dysfunction was higher in the conventional group (9/11, 25% vs 2/11, 5%; p = 0.01). A higher incidence of persistent voiding dysfunction was also observed after segmental resection by conventional laparoscopy (25% vs 4.8%, p = 0.01). Our results support the use of robotic surgery as an alternative to conventional laparoscopy for discoid excision and segmental resection for colorectal endometriosis.
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Affiliation(s)
- Adrien Crestani
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France.
| | - Marjolaine Le Gac
- Department of Obstetrics and Reproductive Medicine, Sorbonne University, Hôpital Tenon, 4 rue de la Chine, Paris, France
| | - Éric de Labrouhe
- Department of Obstetrics and Reproductive Medicine, Sorbonne University, Hôpital Tenon, 4 rue de la Chine, Paris, France
| | - Cyril Touboul
- Department of Obstetrics and Reproductive Medicine, Sorbonne University, Hôpital Tenon, 4 rue de la Chine, Paris, France
- Clinical Research Group (GRC) Paris 6, Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), Paris, France
| | - Sofiane Bendifallah
- Department of Obstetrics and Reproductive Medicine, Sorbonne University, Hôpital Tenon, 4 rue de la Chine, Paris, France
- Clinical Research Group (GRC) Paris 6, Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), Paris, France
| | - Clément Ferrier
- Department of Obstetrics and Reproductive Medicine, Sorbonne University, Hôpital Tenon, 4 rue de la Chine, Paris, France
- Clinical Research Group (GRC) Paris 6, Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), Paris, France
| | - Yohann Dabi
- Department of Obstetrics and Reproductive Medicine, Sorbonne University, Hôpital Tenon, 4 rue de la Chine, Paris, France
- Clinical Research Group (GRC) Paris 6, Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), Paris, France
| | - Emile Darai
- Department of Obstetrics and Reproductive Medicine, Sorbonne University, Hôpital Tenon, 4 rue de la Chine, Paris, France
- Clinical Research Group (GRC) Paris 6, Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), Paris, France
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Parra RS, Valério FP, Zanardi JVC, Féres O. Regarding "Rectal Shaving for Bowel Endometriosis by a Laparoscopic Reverse Submucosal Dissection: Points to be Highlighted". J Minim Invasive Gynecol 2021; 28:1953. [PMID: 34500065 DOI: 10.1016/j.jmig.2021.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 07/22/2021] [Indexed: 11/30/2022]
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Chou D, Rosen D, Cario G, Choi S, Bukhari M, Abbott J, Perera S, Condous G, Wynn-Williams M, Al-Shamari M. Author's Reply. J Minim Invasive Gynecol 2021; 28:1953-1954. [PMID: 34500064 DOI: 10.1016/j.jmig.2021.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 08/27/2021] [Indexed: 11/17/2022]
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