In a latest research revealed within the journal JCM, researchers comprehensively in contrast the efficacy of two minimally invasive surgical strategies for treating deep endometriosis: typical laparoscopy (CL) and robotic-assisted laparoscopy (RAL). They aimed to judge the perioperative and postoperative outcomes of each strategies in a pattern of Mexican sufferers with deep endometriosis.
Background
Minimally invasive surgical procedure has a number of advantages over open surgical procedure for the therapy of endometriosis, reminiscent of decrease charges of issues, an infection, and ache, and shorter hospital stays. Endometriosis is a power situation affecting thousands and thousands of ladies worldwide, inflicting pelvic ache, infertility, and lowered high quality of life. It happens when endometrial tissue, which generally strains the uterus, grows exterior the uterine cavity, forming lesions that may invade organs such because the bladder, ureters, and rectum. This is called deep endometriosis, and it requires surgical therapy to take away the affected tissues and restore regular operate.
CL makes use of small incisions and a digital camera to information the surgeon’s devices, whereas RAL employs a robotic system to reinforce the surgeon’s imaginative and prescient, precision, and dexterity. CL has limitations, together with a two-dimensional view, restricted vary of movement, hand tremors, and ergonomic challenges for the surgeon. RAL addresses these limitations by offering a three-dimensional view, elevated vary of movement, tremor filtering, and improved ergonomics. Nevertheless, RAL is related to increased prices, longer operative occasions, and a studying curve.
Earlier research have in contrast CL and RAL for the therapy of endometriosis, however the outcomes have been inconsistent and controversial. Some research report higher outcomes with RAL by way of blood loss, ache, and issues, whereas others present no important distinction and even worse outcomes with RAL. Most of those research have been carried out in developed international locations the place RAL is extra extensively accessible. Subsequently, there’s a lack of proof on the use and efficacy of RAL for endometriosis therapy in growing international locations, the place RAL is much less widespread and costlier.
Concerning the Analysis
On this paper, the authors carried out a comparative research together with 93 sufferers recognized with endometriosis and handled with both CL or RAL minimally invasive surgical procedure between March 2015 and August 2023 at a tertiary hospital in Mexico Metropolis. The hospital’s surgical orientation committee decided the kind of surgical procedure, contemplating the affected person’s comorbidities, stomach surgical historical past, and endometriosis severity.
The researchers used the endometriosis infiltrating the rectovaginal septum, uterosacral ligaments, vagina, and/or bowel (ENZIAN) classification to grade the depth and site of endometriosis lesions. Different elements thought-about included age, physique mass index (BMI), earlier medical therapy, and extrauterine places of endometriosis.
The research evaluated a number of key outcomes together with operative time, blood loss, postoperative size of keep, postoperative ache, and perioperative issues. It additionally analyzed correlations between these outcomes and elements such because the ENZIAN classification, the Charlson Comorbidity Index, and BMI. Statistical exams have been used to check outcomes between the CL and RAL teams and to evaluate the importance of correlations.
Analysis Findings
The RAL group offered a considerably increased BMI in comparison with the CL group, however the teams remained related by way of age, comorbidities, ENZIAN classification, earlier medical therapy, and extrauterine location of endometriosis. No important distinction was proven in operative time or blood loss between the 2 teams, though the RAL group skilled an extended operative time and fewer blood loss than the CL group.
Nevertheless, a major distinction was present in postoperative size of keep and postoperative ache, with the RAL group having a shorter keep and fewer ache than the CL group. There was no important distinction in perioperative issues between the 2 teams, though the CL group had one case of conversion to open surgical procedure and the RAL group had three instances of surgical accidents.
The researchers additionally discovered that operative time was considerably correlated with blood loss and hospitalization size in each teams, however not with the ENZIAN classification or the Charlson Comorbidity Index. Moreover, hospitalization size was considerably correlated with blood loss in each teams and with BMI solely within the CL group.
Conclusion
In abstract, each RAL and CL proved efficient for treating endometriosis in Mexican sufferers. RAL confirmed advantages over CL with much less postoperative ache and shorter hospital stays, enhancing high quality of life and decreasing healthcare prices. Transferring ahead, the researchers really helpful long-term research to check each strategies and assess RAL’s influence on endometriosis recurrence and fertility. In addition they emphasised the necessity for extra proof on RAL’s use and effectiveness in growing international locations, the place it’s much less accessible and costlier.
Journal Reference
Bandala, C.; Cifuentes-Chacón, J.P.; Cortes-Vázquez, A.; Ruz-Barros, R.; Garrocho-Hernández, L.; Cortes-Algara, A. Efficacy between Typical Laparoscopy and Robotic Surgical procedure in Mexican Sufferers with Endometriosis: A Comparative Examine. J. Clin. Med. 2024, 13, 3576. https://doi.org/10.3390/jcm13123576, https://www.mdpi.com/2077-0383/13/12/3576