Japan: A recent case study has demonstrated the effectiveness of nerve-sparing deep endometriosis (DE) surgery combined with rectal discectomy using the da Vinci SP robotic system. This minimally invasive approach offers new hope to patients suffering from the debilitating symptoms associated with deep endometriosis, including severe pelvic pain and reduced quality of life.
The researchers wrote in Fertility and Sterility that this is believed to be the first documented use of the da Vinci SP in nerve-sparing deep endometriosis surgery and discectomy.
He further added, “The new single-port robotic system offers the same surgical quality as traditional multi-port laparoscopic and robotic platforms, while also providing cosmetic benefits for the treatment of complex pelvic disease.”
Kiyoshi Kanno and colleagues from the Department of Obstetrics and Gynecology, Kurashiki Medical Center, Kurashiki, Okayama Prefecture, aimed to demonstrate the anatomical and technical essentials of nerve-sparing DE surgery with rectal discoid resection using a novel single-port robotic system.
This study was conducted at an urban general hospital. Single-incision laparoscopic surgery is a valuable treatment in gynecology due to its excellent cosmetic results, but it has challenges such as reduced internal triangulation and interference with non-articulating instruments, limiting its scope of application.
A 46-year-old woman was referred for consultation because of severe pelvic pain, dysmenorrhea, and painful defecation. Magnetic resonance imaging revealed uterine adenomyosis, bilateral ovarian endometriosis, and 3 cm of rectal endometriosis. CT colonography confirmed a 38% rectal stricture. Surgery was performed using a novel single-port robotic system.
The primary outcome measures were the technical feasibility and safety of intrapelvic complex DE surgery using a novel single-port robotic platform.
Key findings include:
The surgery was performed in nine steps using the da Vinci SP Surgical System (Intuitive Surgical, Sunnyvale, CA). The surgical steps were similar to traditional multiport laparoscopic and robotic surgery, demonstrating that traditional laparoscopic and robotic surgery techniques are fully transferable to this new system. The steps were as follows:
Adhesiolysis and adnexal surgery, separation of the nerve layer, incision of the ureter, recanalization of the pouch of Douglas, complete removal of deep endometriotic lesions while preserving the nerve layer, hysterectomy (if the patient chooses non-sterilization), rectal discectomy using a circular stapler. The new single-port system offers several advantages, including high-resolution 3D visualization, articulated instruments (triangulation of intracorporeal instruments), and improved dexterity and range of motion. These advantages allow for precise dissection even in challenging situations such as deep endometriosis.
“As more centers adopt the da Vinci SP System for complex gynecologic surgery, this nerve-sparing technique may become the standard of care in the treatment of deep endometriosis and provide a safer and more effective treatment option for patients,” the researchers concluded.
reference:
Kanno, K., Yanai, S., Sawada, M., Sakate, S., & Andou, M. (2024). Nerve-sparing deep endometriosis surgery with rectal discoid resection using the da Vinci SP. Infertility and Sterility. https://doi.org/10.1016/j.fertnstert.2024.07.015
