THE ROBOTIC REVOLUTION: REDEFINING PRECISION AND OUTCOMES IN MODERN SURGERY

Robotic Surgery - The Best Choice for Fertility Preservation in Endometriosis Treatment

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Endometriosis is a condition which beyond grade 2 cannot be managed medically. Patients with grade 3 or 4 experience severe pain affecting quality of life. Quoting a case of a 28-year-old woman with grade 4 endometriosis and bilateral endometriotic masses, who came to us in debilitating pain. Being unmarried, she was kept on hormone therapy by several doctors but continued to suffer cyclical pain, constant period pain and dependency of daily painkillers. CA 125 helps assess endometriosis, but MRI with contrast and clinical examination are best for diagnosis. She was a clear surgical candidate, but her parents were hesitant. After counselling on risks like blocked tubes and worsening pain over the years, we proposed the option of surgery with fertility preservation. Adhesions were present, but her tubes were saved, cysts removed, and she was placed on hormone therapy post-surgery. Two years later, she married and delivered a healthy baby. Early treatment, even at 16-18 years, preserves fertility. Any girl with grade 3 or 4 endometriosis unresponsive to medication or dependent on painkillers needs surgery, regardless of marital status.

Initially, conservative management is tried for three to four months for every patient, but surgery should be considered if it does not help. Surgery types include open, laparoscopic, and robotic. Open surgery is not a favourable option especially in young girls who end up getting a big scar on the belly.

Endometriotic spots and adhesions can be as minute as 5mm and adhesions can be hidden anywhere in the abdomen, hence laparoscopic is not a good option as it fails to give this kind of magnification and also does not prevent recurrence of the disease.

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