RESUMEN
STUDY OBJECTIVE: To assess the feasibility, effectiveness and safety of the robotic surgical approach in the treatment of severe diaphragmatic endometriosis (DE). DESIGN: Retrospective single-center study using data prospectively recorded in the Franco-European Multidisciplinary Institute of Endometriosis (IFEMendo) database and National observatory for endometriosis (NoEndo) database. SETTING: Tertiary referral center. Endometriosis care center. PATIENTS: Sixty consecutive patients undergoing robotic excision of severe DE from January 2020 to July 2023. INTERVENTIONS: Robotic excision of severe DE. MEASUREMENT: Categorical and continuous variables were evaluated and compared using descriptive statistics. A p-value of <0.05 was considered statistically significant. MAIN RESULTS: Full thickness diaphragmatic resection was performed in 76.7% of patients (46/60), partial diaphragmatic muscle resection in 10% (6/60) of cases. Peritoneal stripping technique was performed in 60% (36/60) of patients, divided as follows: as the only technique in case of extensive superficial diaphragmatic involvement in 13.3% of cases (8/60); in addition to full-thickness or partial diaphragmatic resection in case of concomitant multiple foci in 46.7% of patients (28/60). Median operative time was 79.6 minutes with no statistically significative difference related to the surgeon performing surgery (p>0.05). Intraoperative and postoperative complications occurred in 1.7% (1/60) and 6.6% (4/60) of cases, respectively. Diaphragmatic hernia (Clavien-Dindo 3b) was the most common postoperative complication and required surgical repair in all cases. Median hospital stay was 24 hours. The rate of patients with complete recovery from DE symptoms has gradually increased during follow-up, reaching 89% after 12 months from surgery. CONCLUSION: In this case series, robotic treatment of severe diaphragmatic endometriosis in expert hands was feasible, effective and safe. SUMMATION: A robotic stepwise approach allows safe and radical excision of a severe form of diaphragmatic endometriosis.