eP456 - Surgical Outcomes After Robotic Resection of Deep Infiltrating Endometriosis of the Bowel

Sunday, June 2, 2024

3:48 PM – 3:53 PM ET, USA

Location: Baltimore Convention Center, Room 318-320

ePoster Presenter(s)

Poppy Addison, MD

Fellow
Mayo Clinic
Mayo Clinic
Rochester, MN, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no relevant relationships with ineligible companies.

Author(s)

KS

Kelsey Stewart, MD

Gynecology Fellow
Mayo Clinic
Rochester, Minnesota, United States

Disclosure information not submitted.
DF

Davide Ferrari, MD

Research fellow
Mayo Clinic
Rochester, Minnesota, United States

Disclosure information not submitted.
Richard Garfinkle, MD, MSc, PhD

Fellow
Mayo Clinic (Rochester, MN)
Mayo Clinic (Rochester, MN)
Rochester, MN, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no relevant relationships with ineligible companies.
WP

William Perry, MBChB MPH FRACS FACS FASCRS (he/him/his)

Assistant Professor
Mayo Clinic
Mayo Clinic
Rochester, MN, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.
David w. larson, MD MBA

consultant and professor of surgery
mayo clinic
rochester, Minnesota, United States

Disclosure information not submitted.
AC

Adela G. Cope, MD

Senior Associate Consultant, Assistant Professor in Obstetrics and Gynecology
Mayo Clinic
Rochester, Minnesota, United States

Disclosure information not submitted.
ZK

Zaraq Khan, MBBS

Consultant surgeon
Mayo Clinic
Rochester, Minnesota, United States

Disclosure information not submitted.
CL

Carrie Langstraat, MD

Consultant surgeon
Mayo Clinic
Rochester, Minnesota, United States

Disclosure information not submitted.
TB

Tatnai Burnett, MD

Consultant surgeon
Mayo Clinic
Rochester, Minnesota, United States

Disclosure information not submitted.

Senior Author(s)

Behm T. Kevin, M.D., FACS

Assistant Professor of Surgery Division of Colon and Rectal Surgery
Mayo Clinic
Rochester, Minnesota, United States

Disclosure information not submitted.

Purpose/Background: Endometriosis is characterized by implantation of ectopic endometrial tissue outside of the uterus. It can involve deeply infiltrating disease in 1-2% of cases including >1cm nodules invading various depths of bowel, most often the rectosigmoid colon. Recent advances of the robotic platform have made endometriosis surgery more technically feasible and an attractive minimally invasive approach. This study aimed to assess the safety and feasibility of robotic surgery for women undergoing resection of advanced endometriosis involving the bowel.Methods/Interventions: A retrospective review of all women with histologically proven endometriosis of the bowel undergoing resection with a gynecologist and gynecology oncologist or colorectal surgeon between January 1, 2018 and October 1, 2023 was undertaken at a single academic tertiary institution. Demographics, surgical outcomes and intra-operative and postoperative complications were reviewed. The primary outcome measure was peri-operative complications. Secondary outcome measures were conversion to open, operative time, blood loss, bowel margin status and length of stay.Results/Outcomes: Of 99 women included, the most common indication for surgery was chronic pelvic pain (50.5%), followed by dysmenorrhea (41.4%). The most common bowel procedures performed were low anterior resection (52.5%), followed by appendectomy (40.4%) and shave excision of the rectum (22.2%). For the non-bowel component of each procedure, the the most commonly performed were hysterectomy (39.4%), salpingectomy (38.4%), oophorectomy (28.3%), and ovarian cystectomy (24.2%). Most women had the highest American Society for Reproductive Medicine (ASRM) stage of endometriosis (66.7%). Only one patient required a conversion to open, and one required diverting loop ileostomy for a low anastomosis. Mean operative time was 441 ± 145 minutes, and mean blood loss was 151 ± 122 mL. Bowel margins were negative in 58.6% of women, positive in 9.1% and not assessed pathologically in 32.3%. Length of stay ranged from 0 to 5 days, median two days. Within a 90-day timeframe, there were two readmissions (2%) and 14 emergency department visits (14.1%). Three women experienced a complication at least CD grade III, one for ventral hernia, another for vaginal cuff dehiscence, and the final for a deep SSI. No patients experienced an anastomotic leak. Mean follow up was 22.4 ± 16.5 months; over this period two women required reoperation for endometriosis. One woman had recurrence of her pelvic pain and underwent diagnostic laparoscopy that revealed small residual endometriosis in the pelvis not involving the bowel. The second had originally undergone fertility-sparing surgery, had persistence of dysmenorrhea, and was reoperated for a hysterectomy. Of 44 women who underwent fertility sparing procedures, six became pregnant and successfully delivered.Conclusion/

Discussion: In this cohort of women undergoing multi-disciplinary robotic resection for advanced endometriosis involving the bowel, there was a short length of stay and low postoperative morbidity despite long operative times with multiple procedures performed.