Innovative Surgery: Nerve-Sparing Endometriosis Treatment Achieved with Single-Port Robotics, Study Finds

This seems to be the first documented use of the da Vinci SP for nerve-sparing deep endometriosis surgery and rectal discoid resection, the researchers wrote in Fertility and Sterility.

Adding that, "the new single-port robotic system can deliver the same surgical quality as traditional multi-port laparoscopic and robotic platforms, while also offering cosmetic benefits for treating complex pelvic conditions."

Kiyoshi Kanno, Department of Obstetrics and Gynecology, Kurashiki Medical Center, Kurashiki, Okayama, Japan, and colleagues aimed to demonstrate the anatomical and technical highlights of nerve-sparing DE surgery with rectal discoid resection using a newer single-port robotic system.

The study was conducted at an urban general hospital. Single-port laparoscopic surgery is a valuable approach in gynecology due to its excellent cosmetic outcomes; however, it presents challenges such as reduced intracorporeal triangulation and conflicts with non-articulating instruments, which have limited its range of indications.

A 46-year-old woman was referred for evaluation due to severe pelvic pain, dysmenorrhea, and pain during defecation. Magnetic resonance imaging revealed uterine adenomyosis, bilateral ovarian endometriomas, and 3 cm of rectal endometriosis. CT colonography confirmed a 38% stenosis of the rectum. The surgical procedure was performed using a newer single-port robotic system.

The primary outcome measures were technical feasibility and safety of intrapelvic complex DE surgery using a newer single-port robotic platform.

The following were the key findings:

• The procedure was conducted in nine steps using the da Vinci SP surgical system (Intuitive Surgical, Sunnyvale, California). The surgical steps mirrored with conventional multi-port laparoscopic or robotic surgeries, indicating that traditional laparoscopic or robotic skills are highly transferable to this newer system. The steps included:
  • Adhesiolysis and adnexal surgery
  • Separation of the nerve plane
  • Dissection of the ureter
  • Reopening the pouch of Douglas
  • Complete removal of deep endometriosis lesions while preserving the nerve plane
  • Hysterectomy (if the patient opts for non-fertility-sparing surgery)
  • Rectal discoid resection using a circular stapler.
• The newer single-port system offered several advantages, including high-resolution three-dimensional visualization, articulating instruments (intracorporeal instrument triangulation), and improved dexterity and range of motion.
• These advantages allow precise dissection even in difficult situations such as deep endometriosis.

"As more centers adopt the da Vinci SP system for complex gynecological surgeries, this nerve-sparing technique may become a standard practice in managing deep endometriosis, offering patients a safer and more effective treatment option," 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 da Vinci SP. Fertility and Sterility. https://doi.org/10.1016/j.fertnstert.2024.07.015