Robotic Natural Orifice Specimen Extraction with Totally Intracorporeal Anastomosis Associated with Firefly Fluorescence: Bowel Resection for Deep Infiltrating Endometriosis

Abstract

Objective:

The aim of this study was to explore the effects and applications of a robotic minimally invasive bowel-segmental resection, following intracorporeal anastomosis for treatment of deep infiltrating endometriosis (DIE). The procedure reconciled a totally intracorporeal anastomosis (TIA) procedure and robotic natural-orifice specimen extraction (R-NOSE) associated with Firefly™ fluorescence (F) technology (Intuitive Surgical Inc., Sunnyvale, CA) for optimizing outcomes in colon and rectal resection. The authors' initial group experience is also mentioned.

Materials and Methods:

Fifty-six patients with DIE of the colon and rectum underwent the surgical procedure in a tertiary-care referral institution for endometriosis. A standardized robotic procedure was performed with bowel resection and indocyanine green–induced F used for bowel-perfusion assessment. Specimen withdrawal was performed through natural orifices. Patients underwent the surgical procedures from December 2015 to October 2019. Surgical outcomes data and patient follow-ups are reported.

Results:

All patients had robotic minimally invasive bowel segmental resection, following intracorporeal anastomosis. The group's mean age was 36.8 (range: 28–46 years); with a mean body mass index of 22.88 kg/m² (range: 18.9–28.3 kg/m²). In all cases, end-to-end position anastomoses were performed, using a circular stapler; no conversion or diverting stoma were needed. All patients had indocyanine F imaging assessment for bowel and anastomosis perfusion. Mean hospitalization was 4.5 days (range: 3–6 days), and no mortality occurred. No anastomotic leakage or rectovaginal fistula were observed.

Conclusions:

R-NOSE with TIA including Firefly F is a safe and feasible minimally invasive approach to benign bowel disease, reconciling prevalent procedures for endometriosis and colorectal surgical treatment. (J GYNECOL SURG 36:128)