Robotic Treatment of Colorectal Endometriosis

Bowel endometriosis is the presence of ectopic endometrial glands and stroma infiltrating the intestinal wall and causing bowel symptoms and pain. When hormonal therapies fail, surgery becomes the treatment of choice and nowadays a minimally invasive approach is the standard of care. We usually adopt a robotic three-trocar technique with a 12-mm infraumbilical camera port, two 8-mm robotic accesses and one or two laparoscopic ports. Eradication of deep infiltrating endometriosis is a multidisciplinary surgery involving gynecologists in all cases and often colorectal surgeons and urologists. Three techniques have been generally proposed for the surgical treatment of bowel endometriosis: rectal shaving, disc excision and segmental bowel resection. The first two surgeries can be performed fully robotically. Segmental bowel resection requires two assistant laparoscopic trocars. The main advantages of robotic surgery are a 3D view, a stable camera platform, articulated instruments, and better ergonomics for the surgeon. All these features could increase the accuracy of robotic dissection compared to laparoscopic dissection, theoretically allowing for better long-term functional outcomes. The main drawbacks include longer operative time and higher costs with similar postoperative results.