Patient-Reported Outcomes after Robotic Resection of Deep Endometriosis of the Bowel

BACKGROUND: While minimally invasive surgery is the current surgical standard of care for excision of deep endometriosis of the bowel, there is little literature evaluating patient-reported outcome measures following a multidisciplinary, robotic approach. OBJECTIVE: This study aimed to assess the functional outcomes of robotic surgery for patients undergoing resection of deep endometriosis involving the bowel. DESIGN: Retrospective cohort review. SETTINGS: A single academic tertiary institution. PATIENTS: Patients with endometriosis of the bowel undergoing multidisciplinary resection between January 1, 2018, and October 1, 2023. MAIN OUTCOME MEASURES: A survey assessing functional outcomes on a Numeric Rating Scale preoperatively and at multiple points postoperatively. RESULTS: Of 92 eligible patients, 41 completed a preoperative survey and at least one postoperative survey. Among these 41 patients, overall pain improved postoperatively from 5.3 ± 2.7 (Numeric Rating Scale) to a nadir of 1.6 ± 1.9 at 6 months and 2.3 ± 3.0 at 12 months (p < 0.001). Preoperative pain at ovulation (mean 4.2 Numeric Rating Scale ± 3.7), pre-period pain (4.9 ± 3.5), period pain (5.7 ± 3.6) and post-period pain (3.3 ± 3.3) all decreased to a mean of 1 at 12 months postoperatively (p < 0.001). The proportion of patients reporting pain impacting work decreased from 88% preoperatively to <40% postoperatively (p < 0.001). The proportion of patients happy with their bowel function increased from 39% preoperatively to 63.2% at 1 month, 80.0% at 6 months, and 69.2% at 12 months postoperatively (p = 0.014). LIMITATIONS: Only 31.7% of patients responded to their 12-month survey, tertiary care center, low diversity in patient demographics, retrospective design. CONCLUSION: In this cohort of patients undergoing multi-disciplinary robotic excision for advanced endometriosis involving the bowel, patients reported significantly improved pain and quality of life measures. See Video Abstract.