Robot-assisted laparoscopy does not have demonstrable advantages over conventional laparoscopy in endometriosis surgery: a systematic review and meta-analysis

Abstract

Background Endometriosis is a chronic condition affecting 6–10% of women of reproductive age, with endometriosis-related pain and infertility being the leading symptoms. Currently, the gold standard treatment approach to surgery is conventional laparoscopy (CL); however, the increasing availability of robot-assisted surgery is projected as a competitor of CL. This study aimed to compare the perioperative outcomes of robot-assisted laparoscopy (RAL) and CL in endometriosis surgery. Objectives We aimed to compare the effectiveness and safety of these two procedures. Methods A systematic search was conducted in three medical databases. Studies investigating different perioperative outcomes of endometriosis-related surgeries were included. Results are presented as odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CI). Results Our search yielded 2,014 records, of which 13 were eligible for data extraction. No significant differences were detected between the CL and RAL groups in terms of intraoperative complications (OR = 1.07, CI 0.43–2.63), postoperative complications (OR = 1.3, CI 0.73–2.32), number of conversions to open surgery (OR = 1.34, CI 0.76–2.37), length of hospital stays (MD = 0.12, CI 0.33–0.57), blood loss (MD = 16.73, CI 4.18–37.63) or number of rehospitalizations (OR = 0.95, CI 0.13–6.75). In terms of operative times (MD = 28.09 min, CI 11.59–44.59) and operating room times (MD = 51.39 min, CI 15.07–87.72;), the RAL technique remained inferior. Conclusion RAL does not have statistically demonstrable advantages over CL in terms of perioperative outcomes for endometriosis-related surgery. Graphical abstract

Efficacy between Conventional Laparoscopy and Robotic Surgery in Mexican Patients with Endometriosis: A Comparative Study

“…Minimally invasive surgery for the management of endometriosis has significant benefits, with lower rates of surgical complications, infection, and postoperative pain, and shorter hospital stays than open surgery [ 15 , 17 ]. Currently, CL is used more frequently than RAL in the management of endometriosis because it is a more feasible technique because of the availability of equipment and staff.…”

“…The advantages of RAL in early-stage endometriosis are not entirely clear [ 14 ]. In advanced and deep infiltrating endometriosis, comparative studies have not reported that RAL is better than CL in terms of perioperative outcomes; however, it has been mentioned that RAL has practical advantages over CL from the surgeon’s point of view since better posture implies less deterioration in health, and better maneuverability can lead to more precise treatment [ 15 ]. In addition, it has been shown that RAL is more efficient at locating and resecting a greater number of endometriotic foci than CL, which significantly reduces symptoms and recurrence [ 16 ].…”