The role of robotic surgery for endometriosis

Endometriosis is a chronic gynecologic disorder characterized by chronic pelvic pain and infertility that affects approximately 11% of reproductive-aged women. Medical or surgical treatment is essential to manage symptoms and reduce recurrence. When surgical treatment is needed, laparoscopy is considered the gold standard treatment. However, the severity of the disease varies from simple endometrioma to bowel and urinary tract endometriosis, which require radical surgery. With severe endometriosis, even experienced surgeons often need to use laparotomy because of the technical limitations of laparoscopy. Robotic surgery (RS) can be an alternative treatment option because of the advanced visualization, wristed instruments, and ergonomic positioning that it offers to the surgeon. We reviewed previous studies to evaluate the role of RS for endometriosis. Compared with conventional laparoscopy, RS shows similar surgical outcomes, including blood loss and perioperative complications, but it is generally a more time-consuming procedure. RS has no added value for the treatment of early stage endometriosis. However, it does seem to have considerable advantages in complex endometriosis surgery, such as that for advanced stage, bowel, and urinary tract endometriosis, although that has not been shown statistically due to a lack of study. RS can also help prevent conversion to laparotomy and reduce the training period required for inexperienced surgeons. We cannot yet define the definitive role of RS in endometriosis due to its short history, but we note its value for complex surgery. Therefore, RS should be considered in selected patients. Key Words: Endometriosis; Deep infiltrating endometriosis; Robotic surgical procedures; Laparoscopy