Robotic-Assisted Laparoscopic Treatment of Bladder Endometriosis

Study Objective To show the combined surgical approach of cystoscopy and robotic-assisted laparoscopy for a complete and safe resection of bladder endometriosis. Design A clinical case and surgical cystoscopic and robotic approach of bladder endometriosis resection demonstrated by video. Setting Bladder endometriosis is defined as the presence of endometrial glands and stroma in the detrusor muscle and is the most common site affected in urinary tract endometriosis. Surgical treatment should guarantee complete removal of the bladder nodule to minimize recurrence, so transurethral surgery alone should be avoided in favor of segmental bladder resection. Robotic-assisted laparoscopy provides advantages as 3D visualization and facilitation of suturing techniques compared to conventional laparoscopy. Patients or Participants A 32-year-old nulliparous patient, complaining of sensation of incomplete emptying of the bladder and dysuria, with worsening in the menstrual period. Patient had been using combined oral contraception but reported worsening of symptoms since she stopped the use in 2019. During letrozole treatment for infertility she discovered a bladder nodule of probable endometriotic origin. MRI showed signs of deep endometriosis in the vesicouterine recess, with infiltration of the anterior uterine serosa and left round ligament, measuring around 3.0 × 2.0 × 0.9 cm, in addition to the nodular lesion that infiltrates and retracts the upper wall of the bladder, projecting to the bladder lumen of 3.8 × 2.5 × 2.1 cm. Interventions It was performed cystoscopy and bilateral double-J catheter passage, followed by robotic-assisted laparoscopic resection of bladder endometriosis with partial cystectomy. Surgical field was prepared and the paravesical accessed to the bladder nodule. Bladder was sutured with barbed thread and surgical specimen removed by colpotomy. Measurements and Main Results Anatomopathological exam confirms endometriosis. Conclusion Endometriosis of urinary tract can have an appropriate surgical resection by laparoscopic management with or without robotic assistance. Having knowledge of the surgical technique and the platform allows a safe and complete resection, minimizing complications.