Robotic surgery to remove endometriosis involving the urinary tract is a safe and effective treatment option, a retrospective analysis of multiple cases suggests. Also, the rate of surgical complications was low, even in cases involving several organs.
The study with those finding, “Robotic treatment for urinary tract endometriosis: preliminary results and surgical details in a high-volume single-Institutional cohort study,” was published in the journal Surgical Endoscopy.
Pelvic endometriosis is usually divided into three forms: superficial peritoneal lesions, ovarian endometrioma, and deep infiltrating endometriosis (DIE). DIE usually affects areas such as the bowel and urinary tract. In fact, urinary tract endometriosis (UTE) has an estimated prevalence of 6–10%.
The standard treatment for DIE is the surgical removal of endometriosis lesions and, depending on the extent of the disease, multiple surgical interventions may be needed.
In order to minimize the invasiveness of these interventions, robot-assisted approaches have been developed because they represent a much-less-invasive option. However, regardless of studies reporting the safety and effectiveness of these approaches, “there are limited data regarding the minimally invasive surgical treatment for UTE,” the researchers wrote.
In this analysis a team at the University of Florence, Italy, retrospectively reviewed clinical data of women who underwent minimally invasive treatment for DIE involving urinary tract from January 2012 to June 2018.
The study included 74 patients, among whom 28 (37.8%) underwent conventional laparoscopy, and 46 (62.2%) robotic surgery. Only patients treated via robotic surgery were included in the final analysis. Of these, 14 (30.4%) also had bowel involvement, and 32 (69.5%) had genital involvement.
Of the 46 patients receiving robotic surgery, 17 (36.9%) were treated with partial cystectomy (removal of part of the bladder), and 13 (28.3%) with ureteral reimplantation (surgery to fix the ureters that connect the bladder to the kidneys). Ten patients (21.7%) were treated with ureteral lysis, four (8.7%) with removal of bladder endometrial lesion, and two (4.3%) with ureteral end-to-end anastomosis (excision of the injured ureter).
Results showed that the overall rate of postoperative complications was higher in the group of patients treated with conventional laparoscopic approach (28.5%), compared to those treated with robotic surgery (10.9%).
Four patients (8.7%) experienced disease recurrence at the level of urinary tract, in a median follow-up period of 31.3 months. “No statistically significant difference emerged in terms of disease recurrence between laparoscopic and robotic approach,” the researchers noted.
Overall, “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,” the researchers wrote.
“However, it is difficult to provide evidence-based recommendations for the surgical treatment of UTE,” they added. “The heterogeneous nature of UTE lesions requires careful customization of each individual treatment. From this point of view, the surgical management of UTE should be tailor-made… depending on the extent of the ureteral infiltration, the location of the lesion, and on the conditions of the ureter after ureterolysis.”
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