ABSTRACT
OBJECTIVE: To compare robotic-assisted laparoscopy (RAL) and laparoscopy (LPS) for intraoperative and postoperative outcomes, and functional results after a 6-month follow-up period among patients having undergone excision of deep endometriosis (DE) involving the sacral plexus (SP) and sciatic nerve (SN). METHODS: A retrospective analysis of 100 patients included in our prospective database, who underwent surgical eradication of DE involving the SP and SN at our tertiary referral centre between September 2018 and June 2023. Patients were managed by LPS (n = 71) until 2021, and subsequently by RAL (n = 29). RESULTS: Baseline symptoms and distribution of DE lesions were comparable in the two groups. Nerve dissection, nerve shaving, and intra-nerve dissection were performed in 55 (77.5%), 14 (19.7%), and 2 (5.6%) patients in the LPS group, respectively. Nerve dissection and nerve shaving were performed and in 24 (82.8%) and 5 (17.2%) patients in the RAL group, while no cases of intra-nerve dissection were observed (P = 0.434). Mean operative times were 183.71 ± 85.32 min and 177.41 ± 77.19 min, respectively (P = 0.734). There were no reported cases of conversion to open surgery. Intraoperative and early postoperative complications were comparable between the two groups. At 6 months follow up, we observed a significant reduction in sciatic pain in both the LPS group (39.1% vs 15.6%, P < 0.001) and RAL group (37.5% vs 25%, P = 0.001), with no differences in terms of outcomes (P = 0.1). CONCLUSION: Both LPS and RAL result in significant long-term relief of symptoms associated with SP and SN endometriosis. Although surgeons found that RAL improved the quality of excision of these specific DE localizations, our study did not reveal significant advantages in terms of its outcomes.
ABSTRACT
STUDY OBJECTIVE: Evaluate the shift in surgical trends for myomectomy and subsequent changes in the number of uterine ruptures over the years. METHODS: Retrospective analysis utilizing the HCUP-NIS database. Evaluating women, aged 18-40 years, who underwent myomectomy by laparoscopy or laparotomy, and who subsequently had uterine rupture between 2005 and 2014. Statistical analysis focused on the odds ratio of having uterine rupture after a myomectomy and the trends over the years. RESULTS: Of a total 54,146 myomectomies, there were 237 uterine ruptures, which stands for 0.43 %. Mean age was 31.8 years, mainly Caucasians and had private insurance. The procedure was performed mainly by laparotomy with 97.7 %, and 2.3 % were performed by laparoscopy. There was a decrease of total myomectomies from 6646 in 2005-4589 in 2014. The numbers of uterine rupture per 1,000 myomectomies were 4.2 after laparotomy and 10.6 after laparoscopic approach. CONCLUSION: The myomectomy trend changed in recent years with a greater predominance of laparotomies over laparoscopies. Laparoscopic myomectomy may by itself increase the risk for uterine rupture compared to open approach.
