The current role of robotic surgery in endometriosis management

ABSTRACT

Introduction

Endometriosis is a chronic inflammatory disease that affects approximately 10%–15% of women of childbearing age. Laparoscopic surgery is the preferred surgical approach. Recently, robotic surgery has been used for benign gynecologic surgery, but its role in the treatment of endometriosis is still unknown.

Areas covered

We included studies that evaluated the outcomes of robotic surgery for endometriosis. Using the keywords ‘endometriosis’ and ‘robotics’, a comprehensive literature search on PubMed, Embase, and the Cochrane Library was performed in July 2021.

Expert opinion

Robotic surgery for endometriosis has similar outcomes as conventional laparoscopy, with no evidence of increased complication rates. Despite the non-inferiority of the surgical route, the associated costs of robotic surgery limit its availability. Rapid development of robot-assisted surgery necessitates long-term prospective randomized controlled trials. However, the limitations of robotic surgery should not be overlooked. If robotic surgery can facilitate the spread of minimally invasive surgery, it will be necessary to evaluate the cost, availability, complexity of the lesions, and most importantly, the results of patient satisfaction and values of value-based medicine.

KEYWORDS:

• Deep endometriosis
• endometriosis
• laparoscopy
• robotic surgery
• surgical treatment

Article highlights

• Endometriosis is a chronic inflammatory condition defined by the presence of endometrial glands and stroma in extrauterine locations. It affects about 10%–15% of women of childbearing age, with the highest incidence between 25 and 35 years of age.

• The treatment of endometriosis follows three basic principles: pain relief, improvement in fertility, and prevention of disease progression or recurrence. Both medical and surgical therapies play a role in the management of endometriosis. Although conventional laparoscopy is the gold standard for endometriosis surgery, robotic surgery has been used for benign gynecologic surgery.

• Although robotic surgery is safe and no statistically significant differences were found in the operative time and peri- and postoperative complications in the treatment of deep endometriosis, there is a lack of information in the literature if it improves the quality of life and patient satisfaction.

• Compared to standard laparoscopy, some limiting factors of robotic surgery include the higher direct cost of healthcare, absence of tactile feedback when using the robotic console, and scarcity of literature on the grade of lateral heat spread of the different types of energies.

• However, the faster learning curve of robotic surgery may facilitate the spread of minimally invasive surgery. Technical advances may potentially improve surgical performance and decrease perioperative morbidity and the risk of laparoconversion.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose

Additional information

Funding

The authors have no funding to report.