Asymptomatic rectal and bladder endometriosis: a case for robotic-assisted surgery
Chammas Jr. F. Mario; Kim J. Fernando; Barbarino Aurelio; Hubert Nicolas; Feuillu Beno; Coissard Alain; Hubert Jacques;
Denver Health Medical Center, University of Colorado Health Sciences Center, Denver, Colorado, USA
OBJECTIVES: To evaluate the feasibility and safety of robot-assisted laparoscopic partial cystectomy for the treatment of rectal and bladder endometriosis.
MATERIALS AND METHODS: A 23 year-old female with history of infertility and pelvic pain was found to have a 4 cm bladder mass and rectal nodule on pelvic ultrasonography. Patient denied any other genitourinary symptoms.
Cystoscopy and bladder mass biopsy revealed endometriosis. After failure to suppressive hormonal medical therapy a partial cystectomy and resection of a rectal lesion was performed with robotic assistance (da Vinci). The procedure included excision of an ovarian cyst and several peritoneal endometrioid implants.
RESULTS: Robotic-assisted (da Vinci) partial cystectomy with concomitant excision of endometrial nodules from the rectum and ovarian cyst was performed in 185 min. The rectal lesion was excised and primary closure of the rectum was performed. Patient had an uneventful postoperative course and hospital stay. Oral intake was started on postoperative day 1 and follow-up imaging revealed no bladder extravasation or fistula formation. The patient became pregnant 2 years later with ?in vitro? fertilization procedure.
CONCLUSIONS: Robotic-assisted laparoscopic partial cystectomy with excision of rectal nodules for endometriosis can be safely performed.