{"paper_id":"99dc71be-44db-4ee3-b8b0-5901aa2c87c7","body_text":"Role of robot-assisted laparoscopy in deep-infiltrating endometriosis with bowel involvement: a systematic review and application of the IDEAL framework | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Role of robot-assisted laparoscopy in deep-infiltrating endometriosis with bowel involvement: a systematic review and application of the IDEAL framework Hwa Ian Ong, Nastassia Shulman, Patrick Nugraha, Stephen Wrenn, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4084202/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Aims This review aims to evaluate the feasibility of robot-assisted laparoscopic surgery (RALS) as an alternative to standard laparoscopic surgery (SLS) for the treatment of bowel deep-infiltrative endometriosis ( 1 ). Additionally, it aims to provide guidance for future study design, by gaining insight into the current state of research, in accordance with the IDEAL framework. Method A systematic review was conducted to identify relevant studies on RALS for bowel deep infiltrating endometriosis (BDIE) in Medline, Embase, Cochrane Library, and PubMed databases up to August 2023 and reported in keeping with PRISMA guidelines, The study was registered with PROSPERO Registration: CRD42022308611 Results 11 primary studies were identified, encompassing 364 RALS patients and 83 SLS patients, from which surgical details, operative and postoperative outcomes were extracted. In the RALS group, mean operating time was longer (235 ± 112 min) than in the standard laparoscopy group (171 ± 76 min) (p < 0.01). However, RALS resulted in fewer postoperative complications (15.3%) compared to standard laparoscopy (26.5%). Patients in the RALS group experienced a shorter hospital stay (5.3 ± 3.5 days vs. 7.3 ± 4.1 days) (p < 0.01). Research evidence for RALS in BDIE is at an IDEAL Stage 2B of development. Conclusion RALS is a safe and feasible alternative to standard laparoscopy for bowel endometriosis treatment, potentially improving rates of intraoperative and overall postoperative complications despite longer operating times. Endometriosis Robotic Surgery Figures Figure 1 Figure 2 Figure 3 Introduction Endometriosis is a chronic condition characterized by the presence of endometrial-like tissue outside the uterus, affecting around 10% of women of childbearing age.( 2 , 3 ) The ectopic endometrial tissue responds to hormonal fluctuations during the menstrual cycle, leading to pain, inflammation, and adhesion formation in affected organs.( 4 ) Clinical presentations can vary, but women with endometriosis commonly present with pelvic pain, dysmenorrhea, and infertility.( 2 ) Deep-infiltrative endometriosis ( 1 ) is defined as lesions with ≥ 5 mm penetration into the peritoneum, or lesions that invade the muscularis propria of surrounding viscera, affecting more than 20% of women with said condition.( 3 , 5 ) Among the known sites of DIE, bowel involvement is reported in 5–12% of women with endometriosis and can be associated with additional symptoms such as abdominal pain, hematochezia, and dyschezia.( 6 ) A substantial subset of this, ranging from 70–93%, exhibits rectosigmoid involvement.( 5 , 7 ) The primary approach for managing symptoms of bowel deep-infiltrating endometriosis ( 1 ) involves medical therapy, including non-steroidal anti-inflammatory drugs, oral contraceptives, and progestins.( 6 , 8 ) Once medical options have been exhausted, surgical removal has been considered as the next step in the treatment pathway, with standard laparoscopic surgery (SLS) being the current standard approach.( 2 , 6 , 9 ) Various surgical techniques have been described for treating bowel DIE, including rectal shaves, discoid excisions, or segmental resections. Each of the above techniques involves an increasing degree of surgical complexity, exposing patients to the risk of more significant complications. Therefore, the selection of the surgical technique depends on the extent, length and depth of bowel involvement and may vary depending on preferences and experience of the surgeon involved.( 6 , 9 – 11 ) Robot-assisted laparoscopic surgery (RALS) has been shown to be a viable alternative to conventional laparoscopy, providing technical advantages such as improved dexterity and ergonomics, increased range of motion, three-dimensional visualization, and elimination of tremors.( 2 , 9 , 11 ) However, arguments for the feasibility of RALS over standard laparoscopy in the treatment of symptomatic BDIE remains limited in the literature, confounded with discrepancies in outcomes reporting. The main aim of this review is to collate and examine the existing data on RALS in the treatment of BDIE among symptomatic patients. This review aims to assess surgical procedural details, operative parameters, and postoperative outcomes to provide insights into the feasibility of the RALS approach for this population. Furthermore, this review also aims to evaluate the developmental status of the RALS technique based on the IDEAL framework. The framework describes five stages — Idea, Development, Exploration, Assessment, and Long-term study — in the evaluation of emerging surgical techniques, determined by the types of studies already published on said technique.( 12 – 14 ) Understanding the current developmental stage allows researchers to identify gaps in the current evidence base and guides the direction of future research in this space. Methods This review was designed according to PRISMA guidelines( 15 ) and was submitted to the PROSPERO database, CRD42022308611. The search was last accessed in August 2023, of all publications in Medline, Embase, PubMed, and Cochrane Database, reporting on the outcomes of robot-assisted laparoscopic interventions for bowel DIE. Figure 1 shows the key terms and Boolean operators used for the search in the title and abstract fields. A manual search for relevant studies was also carried out to identify additional studies. Inclusion and exclusion criteria Primary studies published up to August 2023 were considered for inclusion to ensure the relevance and timeliness of the findings. This review considered studies discussing RALS procedures for treating bowel DIE, including rectal shaves, discoid excisions, and segmental resections. These studies can either be non-comparative (RALS only) or comparative studies (RALS vs. SLS). The review population was restricted to symptomatic patients diagnosed with bowel DIE through clinical evaluations and/or imaging. Studies with an emphasis on standard laparoscopic or laparotomy interventions only and those examining DIE which did not involve bowel were excluded from consideration. Additionally, literature reviews, conference abstracts, single-case reports, and studies not providing outcomes of interest were excluded. Study characteristics and outcomes of interest The assessment of the study characteristics included variables such as authorship, publication year, geographical origin, study design, sample size, procedures of interest, and key findings. Furthermore, outcomes from each study were extracted using a prospectively designed collection sheet, encompassing technical details, intraoperative parameters, and postoperative outcomes. IDEAL staging and risk of bias assessment The developmental stage of RALS for BDIE was determined using the IDEAL framework.( 13 , 14 ) Since the studies were not written in the IDEAL format, the staging was decided based on the considerations put forward by Pennell et al.( 16 ) The methodological quality and risk of bias in included studies were assessed using the Joanna-Briggs Institute (JBI) appraisal tools for case series( 17 ) and cohort studies( 18 ). Data extraction and statistical analysis Two independent reviewers (PN, NS) conducted title and abstract screening, full-text inclusion, and data extraction, with disputes settled with another reviewer (HO) if consensus was not reached. Data were summarized in a narrative synthesis and the Chi-squared test, Fisher’s exact test, and Student’s t -test were used for the comparison of categorical and numerical variables, where appropriate. In cases where variables were presented in the form of median/range, the mean/standard deviation were estimated employing methods outlined by Luo et al.( 19 ) and Wan et al.( 20 ). All reported p-values were two-sided, and a significant difference was noted when p < 0.05. Statistical analysis was performed using commercially available software. Results The steps for identifying studies for this review were summarized in the PRISMA diagram (Fig. 2 ). The initial search resulted in 223 studies. After the removal of duplicates, 192 studies underwent title and abstract screening, leaving 25 full-text studies to be reviewed. A further 14 were excluded for reasons highlighted in Fig. 2 , leaving 11 studies( 21 – 31 ) to be included in the review. Study characteristics Table 1 compiles the data describing the studies’ characteristics. In summary, the study range spanned from 2012–2022. Among these studies, nine studies( 21 – 29 ) were non-comparative case series focusing on RALS, whereas two studies( 30 , 31 ) were comparative cohort studies. Overall, the studies included 527 participants, of which 451 received surgical treatment for BDIE (which may have also included concurrent removal of other sites of disease) - consisting of 368 RALS and 83 SLS participants. All participants who had treatment for DIE which did not involve bowel were excluded. Table 1 Characteristics of studies evaluating robotic surgery for the treatment of bowel endometriosis. Author Year Country Study Type Data collection Group Sample size Procedures of interest Key conclusion Ercoli et al.( 21 ) 2012 Italy CS Retrospective RALS 22 RS, SR Use of RALS for bowel DIE treatment is feasible and safe. Cassini et al.( 22 ) 2013 Italy CS Retrospective RALS 19 SR Use of RALS for bowel DIE treatment is feasible and safe. Collinet et al.( 23 ) 2014 Multinational a CS Retrospective RALS Others b 92 72 RS, SR RALS is feasible in the surgical treatment of stage 4 DIE. Siesto et al.( 24 ) 2014 Italy CS Retrospective RALS Others b 42 1 RS, SR Use of RALS for DIE is feasible and safe. Diguisto et al.( 25 ) 2015 France CS Retrospective RALS 28 RS, SR SR with RALS for treatment of DIE is associated with longer OT and LOS when compared to RS. Pellegrino et al.( 26 ) 2015 Italy CS Prospective RALS 25 RS RS with RALS for bowel DIE treatment is feasible and safe. Morelli et al.( 27 ) 2016 Italy CS Prospective RALS 10 SR RALS for bowel DIE treatment is associated with low risks of complication and preservation of urinary and sexual function. Abo et al.( 28 ) 2017 France CS Prospective RALS Others b 32 3 RS, DE, SR Use of RALS for bowel DIE treatment is feasible and safe, but not superior to SLS. Graham et al. ( 29 ) 2019 USA CS Retrospective RALS 15 RS, SR Use of RALS for treatment of bowel DIE is feasible and safe. Raimondo et al.( 30 ) 2021 Italy Co Prospective RALS SLS 22 22 RS, DE, SR Similar operative outcomes between RALS and SLS for bowel DIE treatment, except for longer operative room time. Ferrier et al.( 31 ) 2022 France Co Prospective RALS SLS 61 61 RS, DE, SR RALS provides lower rates of intraoperative complications for DE or SR procedures when compared to SLS. a Belgium, England, France, Italy, Japan b Indicate patient groups with endometrial involvement in sites other than bowel (e.g., bladder, ureter) CS : Case series; Co : Cohort studies; RALS : Robotic-assisted laparoscopic surgery; SLS : Standard laparoscopic surgery; RS : Rectal shaves; DE : Discoid excision; SR : Segmental resection; OT : Operating time; LOS : Length of hospital stay Surgical procedural details Nine studies reported the utilization of the Da Vinci System (Intuitive Surgical, Inc.) as their robotic platform (Table 2 ), with Ercoli et al likely to have also used this system in 2010. Where patient positioning was described, most were positioned in lithotomy, a configuration commonly used in gynecological, rectal, and urological procedures.( 32 ) The depictions of port placements were mostly consistent with what has been described in existing literature.( 11 ) For the two comparative studies,( 30 , 31 ) the assignment of patients into either the RALS or SLS approach did not follow a formal randomization process, as it solely depended on the availability of the robotic theatre and equipment. Table 2 Surgical system set-up and operative indication of studies evaluating robotic surgery for the treatment of bowel endometriosis. Author Robotic system Patient position Number of ports and placement Endometriotic lesion indications Rectal shaving Discoid excision Segmental resection Ercoli et al.( 21 ) NR NR - Three 8mm robotic ports: umbilicus, R IF, L IF - 12mm assistant port: R subcostal - 5mm assistant port: L subcostal Lesions limited to the bowel serosa N/A Infiltration into the rectal mucosa and the presence of more than one intestinal stricture Cassini et al.( 22 ) da Vinci S/Si Modified lithotomy − 12mm camera port: umbilicus - Two 8mm robotic ports: R IF, L IF - 1mm stapler port: R subcostal - 5mm additional port: NR N/A N/A Lesions > 2cm infiltrating the bowel, or presence of multifocal lesions, or circumferential involvement of > 50% Collinet et al.( 23 ) da Vinci S/Si NR - Three to four robotic ports: NR NR N/A NR Siesto et al.( 24 ) da Vinci S Lithotomy − 12mm port: umbilicus - Two 8mm robotic ports: R IF, L IF - 10mm port: L subcostal Lesions limited to the bowel serosa N/A Lesions with infiltrations into layers deeper than the serosa (muscularis and mucosa layer) Diguisto et al.( 25 ) da Vinci S Lithotomy NR Unifocal lesions not involving the mucosal layer. N/A Multifocal or extensive lesion with mucosal involvement Pellegrino et al.( 26 ) da Vinci S Lithotomy − 12mm port: umbilical incision - Two 8mm robotic ports: R IF, L IF - 10mm port: L subcostal Superficial lesions without full-thickness bowel wall infiltration N/A N/A Morelli et al.( 27 ) da Vinci Si Modified lithotomy − 12mm optical port: R of umbilicus - Two 8mm robotic ports: R IF, L IF - 12mm port: suprapubic - 10mm port: R subcostal N/A N/A Lesions involving the bowel muscularis layer Abo et al.( 28 ) da Vinci S/Si Modified lithotomy - Three 8mm robotic ports: left of umbilicus, R IF, and L IF - 10mm assistant port: R IF NR NR Multifocal lesions causing severe bowel stenosis, or an area at risk of postoperative necrosis Graham et al. ( 29 ) da Vinci Si Lithotomy − 12mm port: umbilicus - Two 8mm ports: R IF and L IF - 5mm assistant port: L subcostal Lesions < 1cm or involving < 30% of the bowel circumference N/A Lesions involving > 30% of the circumference of the bowel lumen Raimondo et al.( 30 ) da Vinci Si/Xi NR NR Attempted first for all cases If macroscopic residual disease were observed after rectal shaving Ferrier et al.( 31 ) NR NR - Three 8mm ports: umbilicus, R IF, L IF - 5mm assistant port: NR - 12mm port: R abdomen Superficial lesions without involvement of the mucosal layer Lesions involving the muscularis, ≤ 3cm or <90° of the bowel circumference Multifocal lesions > 3cm in length and involving >90° of the bowel circumference L : Left, R : Right, IF : Iliac fossa, NR : Not reported, N/A : Not applicable to the study In addition, all studies provided insight into at least one of the following techniques: rectal shaves, discoid excisions, and segmental resections. Most studies provided indications regarding the characteristics of endometrial lesions for each procedure (Table 2 ). However, the reporting of indications was not standardized, as each paper puts forward its own distinct criteria. As depicted in Fig. 3 , among the participants who underwent RALS and SLS for BDIE, 59% and 35% had shaves, 8% and 19% had discoid excisions, 33% and 42% had segmental resections. Surgeon Experience When interpreting the results from these studies, it is important to consider the surgical experience, particularly in the RALS group, as many of these studies may represent the surgical learning curve of this new technology. There was significant heterogeneity in the disclosure and experience of surgeons participating in these studies, as summarized in Table 3 , but a trend towards more explicit disclosure of surgical robotic experience can be seen in more recent studies. As expected, all surgeons involved were also trained in laparoscopic surgery. Table 3 Summary of Surgeon Experience in Performing RALS Author Year Surgeon Experience Ercoli et al.( 21 ) 2012 Undisclosed Cassini et al.( 22 ) 2013 Undisclosed. Learning curve acknowledged in discussion. Hybrid laparoscopic approach taken in segmental resections, where standard laparoscopy used to mobilise and anastamose. Collinet et al.( 23 ) 2014 Gynaecologic surgeons trained in laparoscopic surgery. Siesto et al.( 24 ) 2014 Single surgeon with extensive experience in laparoscopic and abdominal gynaecological surgery Diguisto et al.( 25 ) 2015 Undisclosed Pellegrino et al.( 26 ) 2015 Single surgeon with extensive laparoscopic experience. Morelli et al.( 27 ) 2016 Experienced Minimally Invasive Surgeons, performed > 900 cases. Abo et al.( 28 ) 2017 Senior gynaecologic surgeon who could perform rectal shaves and ureterolysis. Only 35 of > 250 cases managed robotically in 3 years Learning curve acknowledged in discussion. Graham et al. ( 29 ) 2019 Surgeons who had performed fellowships in robotic surgery, having performed > 500 robotic cases. Raimondo et al.( 30 ) 2021 Senior surgeons trained in minimally invasive surgery, having performed > 25 robotic cases Ferrier et al.( 31 ) 2022 Experienced gynaecological surgeons trained in minimally invasive surgery, who would perform both RALS and SLS Operative and postoperative parameters The operative and postoperative findings from each study were compiled in Table 4 . Most studies reported these metrics using means and standard deviations ( 33 ) or medians and ranges. However, a few studies either omitted information on some outcomes or reported means/medians without corresponding SD/ranges, resulting in their exclusion from calculations done for Table 5 . Regarding patient characteristics, the groups exhibited comparable age and body mass index profiles (Table 5 ). The mean operating times was 227 ± 104 in the RALS group and 171 ± 76 min in the SLS group (p < 0.01). For the remaining intraoperative metrics, there were no significant differences in blood loss, intraoperative complications, and laparotomy conversions. Table 4 Operative and postoperative findings of studies evaluating robotic surgery for the treatment of bowel endometriosis. Author Group Sample size Age (years) BMI (kg/m 2 ) Operating time (min) Blood loss ( 50 ) Laparotomy conversion n (%) IOC n (%) POC n (%) LOS (days) Ercoli et al.( 21 ) RALS 22 38 [25–45] 21 [17–25] 370 [260–720] a 280 [220–365] b 100 [50–250] a 200 [100–350] b 0 (0) 0 (0) 1 (4.5) 8 [6–10] a 5 [4–7] b Cassini et al.( 22 ) RALS 19 37 [25–45] 21 [17–25] 370 (250–720) 150 [50–350] 0 (0) 0 (0) 2 ( 11 ) 5 [3–8] Collinet et al.( 23 ) RALS 92 34.1 (7.3) 24.4 (8.2) 188.2 (75.7) 127.5 (293.3) 1 (1.1) 4 (4.3) NR 4.2 (2.7) Siesto et al.( 24 ) RALS 42 34 [27.3–45.5] 22.3 [17.2–41] 200 [57–366] 120 [100–1000] 1 (2.4) 0 (0) 2 (4.8) 3 [2–8] Diguisto et al.( 25 ) RALS 28 34.1 (2.1) 24.1 (1.1) 190 ( 51 ) 274 ( 51 ) 1 (3.6) 2 (7.1) NR 4.9 ( 51 ) Pellegrino et al.( 26 ) RALS 25 33.9 (6.1) 21.2 (2.9) 174 [75–300] 0 [0-100] 0 (0) 1 ( 4 ) 0 (0) 3 [2–4] Morelli et al.( 27 ) RALS 10 36.5 [28–47] 22.4 [18.2–25.9] 280 [180–240] 200 [100–400] 0 (0) 0 (0) 1 ( 10 ) 6 [4–7] Abo et al.( 28 ) RALS 32 36 (8.4) 24.5 (5.9) 207 (67) NR 0 (0) NR 3 (9.4) NR Graham et al. ( 29 ) RALS 15 38 ( 2 ) 29 (2.1) 342 (42.7) 283 (91.6) 0 (0) 0 (0) 5 ( 33 ) 2 (1.5) Raimondo et al.( 30 ) RALS SLS 22 22 38 ( 7 ) 36 (5) 24.5 [21–27] 22.5 [21–24] 207 (79) 177 (63) 184 (214) 144 (101) 1 (4.5) 0 (0) 1 (4.5) 0 (0) 4 ( 18 ) 1 (4.5) 8 ( 7 ) 6 (2) Ferrier et al.( 31 ) RALS SLS 61 61 36 ( 7 ) 35 (7) 25 ( 5 ) 26 (8) 208 (90) 169 (81) 161 (141) 188 (266) 2 (3.3) 1 (1.6) 2 (3.3) 6 (9.8) 20 ( 33 ) 21 (34) 7.5 (3.9) 7.8 (4.6) Data are presented either in mean ( 33 ), median [range], or n (%) Ercoli et al. presented separate outcomes for two RALS subgroups: rectal shaves (n = 10) a and segmental resections (n = 12) b . RALS : Robotic-assisted laparoscopic surgery; SLS : Standard laparoscopic surgery; BMI : Body mass index; IOC : Intraoperative complications; POC : Postoperative complications; NR : Not reported Table 5 Comparative analysis of RALS and SLS patient groups. RALS ( n = 368 ) SLS ( n = 83 ) p value Age (years) 35.8 ± 6.1 35.3 ± 6.5 0.52 BMI (kg/m2) 24.5 ± 5.7 25.3 ± 6.9 0.33 Surgical procedure < 0.01 Rectal shaving 217 (59%) 29 (35%) Discoid excision 30 (8%) 19 (23%) Segmental resection 121 (33%) 35 (42%) Operative parameters Operating time (min) 227 ± 104 a 171 ± 76 < 0.01 Intraoperative complications 10 (3.0%) b 6 (7.2%) 0.07 Conversion to laparotomy 6 (1.6%) 1 (1.2%) 0.78 Blood loss ( 50 ) 155 ± 207 c 176 ± 234 0.46 Post-operative outcomes Duration of hospital stay (days) 5.1 ± 3.6 c 7.3 ± 4.1 < 0.01 Grade of complications (Clavien-Dindo Grade) Major complications (III-IV) 15 (4.4%) a 3 (3.6%) Minor complications (I-II) 22 (6.4%) a 19 (22.9%) Data presented either in mean ± SD or n (%) a n = 340; b n = 336; c n = 308; sample size varies due to studies excluded for not reporting outcomes RALS : Robotic-assisted laparoscopic surgery; SLS : Standard laparoscopic surgery; BMI : Body mass index. Regarding postoperative outcomes, the mean hospital stay was 5.1 ± 3.6 days in the robotic group and 7.3 ± 4.1 days in the standard group (p < 0.01). Postoperative complications were stratified based on the Clavien-Dindo classification system to grade adverse events occurring after a surgical procedure.( 34 , 35 ) The classification categorizes complications into grades ranging from I-V, in increasing severity. For the purposes of this study, complications were grouped into minor (I-II) and major (III-IV) complications, excluding Grade V (death) as it was not reported in any studies. Overall, major and minor complications occurred in 4.4% and 6.4% of cases in the robotic group, compared to 3.6% and 22.9% in the standard group. When further broken down into specific types of complications, there was a higher rate of pelvic abscesses in the RALS group (n = 6, 1.7%) compared to the SLS group (n = 1, 1.2%). Anastamotic leak rate of 0.6% in the RALS group (n = 2) lies within acceptable limits. From a functional perspective, 4 studies reported significant improvements in dysmenorrhoea, dyspareunia, dyschezia and chronic pelvic pain within the RALS group at least 6 months post operatively( 21 , 22 , 26 , 30 ) according to the 10 point VAS scale. Raimondo et al also found an equal improvement when compared to SLS( 30 ). Morelli et al found an improvement in quality of life at 6 months( 27 ) and Abo et al found improvements in bowel function up to 24 months post operatively( 28 ). However, the heterogeneity of these measures precluded statistical analysis within the context of this systematic review. Discussion Minimally invasive laparoscopy has been the standard in the surgical treatment of endometriosis, including deep-infiltrative lesions of the bowel.( 2 , 6 , 9 ) However, there are known constraints to standard laparoscopy, which include the loss of three-dimensional visualization, reduced degrees of movement, and the fulcrum effect.( 36 ) The introduction of robotic surgical platforms aimed to address some of these limitations.( 36 , 37 ) While meta-analyses( 38 , 39 ) established the feasibility of robotic surgery as an alternative to standard laparoscopy for treating endometriosis, none addressed it in the context of bowel DIE. A review by Hur and Falcone( 11 ) had a similar focus, providing a general overview of the role of RALS in bowel endometriosis. However, this present study placed an additional emphasis on conducting a comprehensive review in accordance with the PRISMA guidelines and comparative analysis of data using descriptive statistics. Choice of surgical techniques using RALS Significant differences in the choice of surgical techniques emerged between RALS and SLS, with rectal shaves more frequently utilized with RALS (Table 5 ). The higher prevalence of shaves in the robotic group could be attributed to the benefits associated with robot-assisted surgery, which offers better vision to aid in assessment of disease depth, allowing surgeons to perform complete excisions with clear margins with rectal shaves, and improved dexterity enabling easier and secure suturing within the confines of the pelvis. When more extensive resection is performed, the technical complexities involved may diminish some of the advantages offered by robotic surgery. Another factor to consider is the inherent variation of surgical indications described in the studies. The choice of technique itself is dependent upon several factors, including the extent and depth of bowel involvement.( 6 , 9 – 11 ). This inherent variability in decision-making reflects the multitude of factors which influence the personalized nature of treatment decisions. The decision to perform segmental resections balance a lower recurrence risk against the increased risk of major complications, particularly anastamotic leak and requirement for stoma. In the cohort of patients reviewed, 2 anastamotic leaks were identified, both within the RALS group. This could be explained by a number of factors. Sampling bias is likely to have played a significant role in this finding, particularly in the SLS group, where only 35 patients underwent segmental resection. A large multicenter meta-analysis, including 1622 patients puts this risk at 1.9%( 40 ). Comparatively the rate of 0.6% in the RALS group is within acceptable limits. Furthermore, as these cohort studies are unblinded, selection bias may be present, where more complex cases were undertaken when the robotic system is available, as acknowledged by Graham et al( 29 ),. However, the increased prevalence of segmental resections within the SLS cohort itself introduces a potential confounding variable, given its association with prolonged surgical duration and an increased risk of postoperative complications.( 41 , 42 ). These factors can naturally influence other surgical outcomes, such as recovery times and complication rates. Operative and postoperative outcomes of RALS This review suggests that RALS is feasible and safe for treating symptomatic patients with bowel deep-infiltrating endometriosis, leading to minimal surgical complications and infrequent conversion to laparotomy. Additionally, there is a trend towards fewer intraoperative complications in the robotic group, although this has not reached clinical significance (Table 5 ). One study( 27 ) even associates RALS with the preservation of urinary function and sexual well-being up to a year post-surgery. Intraoperative blood loss, another important metric influencing surgical complications, was likewise found to exhibit no significant differences between the groups. The studies included in this review indicate that RALS confers at least an equal benefit in terms of resolution of preoperative symptoms to SLS, but true statistical analysis was not possible due to the heterogeneity of the data. However, when compared to standard laparoscopy, RALS is associated with significantly longer operating duration, consistent with other reports within the existing literature. Numerous reviews and randomized trials have explored the differences in operating times between RALS and SLS for various subsets of endometriosis patients.( 38 , 39 , 43 ) While many of these studies reached similar conclusions regarding extended operating times with RALS, there were notable variations in the reported data. Factors contributing to these variations include the selective exclusion of patients with bowel involvement or inclusions of superficial endometriosis in these studies, leading to shorter reported operating times. This complexity underscores the importance of considering specific study contexts and inclusion criteria when interpreting data on operating times. Postoperatively, the robotic group exhibits a shorter hospital stay and differences in postoperative complication rates, with a slightly higher rate of major complications and a lower rate of minor complications (Table 5 ). When compared to major laparoscopic studies, with postoperative major complication rates of 2.5% the rate of major complications in this study (4.4% in RALS and 3.6% in SLS) appears high. However, this could be attributable to a smaller sample size (368 and 83 vs 4721)( 44 ). Furthermore, many of these studies acknowledged the learning curve experienced in performing robotic surgery, compared to their significant laparoscopic experience. In addition, it is important to note that the observational nature of these included studies inherently provides evidence of lower quality compared to RCTs.( 45 ) These studies, due to the lack of controlled interventions, have limitations in their ability to establish causal relationships. Translation into clinical practice Prolonged operating time can largely be attributed to the unique characteristics of robotic surgery, with additional time required for tasks such as docking, robot positioning, and troubleshooting technical issues.( 11 , 36 ) Previous research( 46 ) describing surgical treatments of advanced endometriosis had shown that longer durations of surgery potentially increase the physiological stress on the patient, adversely affecting recovery times and postoperative outcomes. Another factor to consider is that operating room time is a valuable resource in healthcare. Prolonged surgeries consume more resources, including personnel, equipment, and facilities – on top of the costs incurred for implementing and maintaining the robotic equipment.( 47 ) Consequently, this can result in higher immediate costs, which may be offset by the significantly shorter length of stay and lower rates of surgical complications. Furthermore, as the use of the robotic systems mature, it is expected that the operating time will decrease as the learning curve is overcome by both the surgeons and their supporting theatre staff. In summary, from a practical perspective, the availability of a robotic system can pose a barrier to the adoption of RALS due to its high start-up costs. Nevertheless, as demonstrated in this review, there are potential benefits to using RALS which can only be fully understood through increased availability and utilization of robotic operating systems within the healthcare system. It is important to note that comprehensive cost-benefit analyses specific to RALS in treating bowel DIE have been lacking thus far. Future research is essential to provide additional perspectives on the medico-economic implications associated with RALS. IDEAL staging of RALS for bowel DIE The evaluation of RALS for the treatment of bowel DIE reveals a dynamic landscape of evolving surgical techniques and research methodologies as evidenced by the studies highlighted in this review. In the early 2010s, studies( 21 , 22 , 24 , 25 ) on this topic predominantly featured single-centre retrospective case series, indicative of the IDEAL Stage 2a (Development).( 16 ) These studies sought to establish the viability and safety of RALS for bowel DIE, along with building consensus on the technical aspects of the procedure and sharing early clinical experiences. However, recent papers( 30 , 31 ) on the technique have transitioned into Stage 2b (Exploration), characterized by prospective cohort studies. This evolution reflects the maturity of the technique, supported by robust findings indicating its feasibility and safety. Studies directly comparing RALS against standard laparoscopy are emerging, shedding light on the learning curves associated with RALS and highlighting the necessity for RCTs to provide more definitive evidence. Based on these considerations, the overall staging of RALS for bowel DIE can be classified as the endpoint of Stage 2b. This signifies a consensus on the maturity of the technique, favourable clinical outcomes, and an understanding of desirable outcome measures.( 16 ) Looking ahead, it is imperative that multicentre RCTs be undertaken to provide higher-quality evidence to investigate the comparative effectiveness of RALS versus SLS. Notably, the upcoming ROBEndo RCT( 48 ) represents a promising step in this direction and holds the potential to influence future research in this field. Limitations It is important to recognize that like any literature review, this analysis may be susceptible to evidence selection, reporting, and publication biases, as well as the inherent biases of the studies previously mentioned.( 49 ) To limit the sources of these biases, several measures were put in place. Firstly, two independent reviewers performed a thorough assessment of the methodology and risk of bias in all the studies (Tables 6 and 7 ). Additionally, strict adherence to PRISMA guidelines ensured a structured review and reporting process. Table 6 JBI checklist for case series( 17 ) Ercoli et al. 20 Cassini et al. 21 Collinet et al. 22 Siesto et al. 23 Diguisto et al. 24 Pellegrino et al. 25 Morelli et al. 26 Abo et al. 27 Graham et al. 28 Were there clear criteria for inclusion in the case series? Y Y Y Y Y Y Y Y Y Was the condition measured in a standard, reliable way for all participants included in the case series? Y Y Y Y Y Y Y Y Y Were valid methods used for identification of the condition for all participants included in the case series? Y Y Y Y Y Y Y Y Y Did the case series have consecutive inclusion of participants? Y Y Unk. Y Y Y Y Y Y Did the case series have complete inclusion of participants? Y Y Unk. Y Y Y Y Y Y Was there clear reporting of the demographics of the participants in the study? Y Y Y Y Y Y Y Y Y Was there clear reporting of clinical information of the participants? Y Y Y Y Y Y Y Y Y Were the outcomes or follow up results of cases clearly reported? Y Y Y Y Y Y Y Y Y Was there clear reporting of the presenting site(s)/clinic(s) demographic information? N N N N N N N N N Was statistical analysis appropriate? Y Y Y Y Y Y Y Y Y Y : Yes; N : No; N/A : Not applicable to study; Unk : Unknown Table 7 JBI checklist for cohort studies( 18 ) Raimondo et al. 29 Ferrier et al. 30 Were the two groups similar and recruited from the same population? Y Y Were the exposures measured similarly to assign people to both exposed and unexposed groups? Y Y Was the exposure measured in a valid and reliable way? Y Y Were the confounding factors identified? Y Y Were strategies to deal with confounding factors stated? Y Y Were the groups/participants free of the outcome at the start of the study (or at the moment of exposure)? N/A N/A Were the outcomes measured in a valid and reliable way? Y Y Was the follow up time reported and sufficient to be long enough for outcomes to occur? Y Y Was follow up complete, and if not, were the reasons to loss to follow up described and explored? Y Y Were strategies to address incomplete follow up utilized? N/A N/A Was appropriate statistical analysis used? Y Y Y : Yes; N : No; N/A : Not applicable to study However, the nature of the included studies inherently provides lower-quality evidence compared to prospective RCTs.( 45 ) While these studies offer valuable insights into real-world clinical practices, the observational nature and lack of controlled interventions limit their ability to establish definitive causal relationships. Furthermore, their vulnerability to confounders presents a concern, given that this review cannot address all potential factors that might influence the outcomes, such as the surgeons’ learning curve for RALS. Lastly, heterogeneity in outcome reporting measures, alongside the lack of studies reporting relevant outcomes such as urinary and sexual function, cost analysis, and fertility, prevents a more comprehensive assessment from being performed. Conclusion Robotic-assisted laparoscopic surgery has emerged as an alternative to conventional laparoscopy in the context of deep-infiltrative endometriosis involving the bowel. Our review suggests that RALS offers potential benefits of reduced postoperative hospital stay and a trend towards lower intraoperative complications, with longer operating times. As surgeons and techniques mature, well-designed randomized studies are imperative to further define the safety and efficacy of RALS in bowel endometriosis, aligning with an IDEAL framework stage of 2b. Future studies should address the impact of the learning curve of robotic surgery, potential differences in resection margins and functional outcomes in DIE, as well compare each technique; rectal shave, discoid excision and segmental resection, to define the advantages and disadvantages of each system. Declarations Author Contribution Conceptualisation - UM, CP, CF, HMMethodology - SWr, DN, CP, NS, PN, HOData Curation, Investigation and Formal Analysis - NS, PN, HOValidation - HM, HO, CF, DP, SWaSupervision - UM, JM, DP, SWa, CF, HMWriting - Original Draft, Visualisation - PN, HO, NSResources - UM, DP, HMProject Administration - SWr, NS, PN, DNWriting - Review & Editing - SWa, HM, CF, HOAll authors reviewed and agree with contents of the manuscript Conflict of Interest : None The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request. References Allgayer H, Dietrich CF, Rohde W, Koch GF, Tuschhoff T. Prospective comparison of short- and long-term effects of pelvic floor exercise/biofeedback training in patients with fecal incontinence after surgery plus irradiation versus surgery alone for colorectal cancer: clinical, functional and endoscopic/endosonographic findings. 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Comparison of robot-assisted and conventional laparoscopy for colorectal surgery for endometriosis: A prospective cohort study. Int J Med Robot. 2022;18(3):e2382. Armstrong M, Moore RA. Anatomy, Patient Positioning. 2023. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing LLC. Available from: . Gerber LH, Hodsdon B, Comis LE, Chan L, Gallin JI, McGarvey CL, 3rd. A Brief Historical Perspective of Cancer Rehabilitation and Contributions From the National Institutes of Health. PM R. 2017;9(9S2):S297-S304. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13. Katayama H, Kurokawa Y, Nakamura K, Ito H, Kanemitsu Y, Masuda N, et al. Extended Clavien-Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today. 2016;46(6):668–85. Catenacci M, Flyckt RL, Falcone T. Robotics in reproductive surgery: Strengths and limitations. Placenta. 2011;32:S232-S7. Chen CCG, Falcone T. Robotic gynecologic surgery: Past, present, and future. Clinical Obstetrics and Gynecology. 2009;52(3):335–43. Chen S-H, Li Z-A, Du X-P. Robot-assisted versus conventional laparoscopic surgery in the treatment of advanced stage endometriosis: a meta-analysis. CEOG. 2016;43(3):422–6. Restaino S, Mereu L, Finelli A, Spina MR, Marini G, Catena U, et al. Robotic surgery vs laparoscopic surgery in patients with diagnosis of endometriosis: a systematic review and meta-analysis. J Robot Surg. 2020;14(5):687–94. Bendifallah SP, Anne; Vesale, Elie; Moawad, Gaby; Daraï, Emile; Roman, Horace. Surgical outcomes after colorectal surgery for endometriosis: Systematic Review and Meta-Analysis. Journal of Minimally Invasive Gynaecology. 2021;28(3):453–66. Daraï E, Bazot M, Rouzier R, Houry S, Dubernard G. Outcome of laparoscopic colorectal resection for endometriosis. Curr Opin Obstet Gynecol. 2007;19(4):308–13. Parra RS, Valério FP, Zanardi JVC, Feitosa MR, Camargo HP, Féres O. Postoperative Complications and Stoma Rates After Laparoscopic Resection of Deep Infiltrating Endometriosis with Bowel Involvement. Rev Bras Ginecol Obstet. 2022;44(11):1040–6. Soto E, Luu TH, Liu X, Magrina JF, Wasson MN, Einarsson JI, et al. Laparoscopy vs. Robotic Surgery for Endometriosis (LAROSE): a multicenter, randomized, controlled trial. Fertil Steril. 2017;107(4):996–1002.e3. Byrne D, Curnow T, Smith P, Cutner A, Saridogan E, Clark TJ, et al. Laparoscopic excision of deep rectovaginal endometriosis in BSGE endometriosis centres: a multicentre prospective cohort study. BMJ Open. 2018;8(4):e018924. Gilmartin-Thomas JF, Liew D, Hopper I. Observational studies and their utility for practice. Aust Prescr. 2018;41(3):82–5. Magrina JF, Espada M, Kho RM, Cetta R, Chang YH, Magtibay PM. Surgical Excision of Advanced Endometriosis: Perioperative Outcomes and Impacting Factors. J Minim Invasive Gynecol. 2015;22(6):944–50. McBride K, Steffens D, Stanislaus C, Solomon M, Anderson T, Thanigasalam R, et al. Detailed cost of robotic-assisted surgery in the Australian public health sector: from implementation to a multi-specialty caseload. BMC Health Services Research. 2021;21(1):108. Terho AM, Mäkelä-Kaikkonen J, Ohtonen P, Uimari O, Puhto T, Rautio T, et al. Robotic versus laparoscopic surgery for severe deep endometriosis: protocol for a randomised controlled trial (ROBEndo trial). BMJ Open. 2022;12(7):e063572. Drucker AM, Fleming P, Chan A-W. Research Techniques Made Simple: Assessing Risk of Bias in Systematic Reviews. Journal of Investigative Dermatology. 2016;136(11):e109-e14. Pieniowski EHA BC, Nordenvall CAM, Westberg KS, Johar AM, Tumlin Ekelund SF, Larsson KR, Pekkari KJ, Jansson Palmer GC, Lagergren P, Abraham-Nordling M. A Randomized Controlled Clinical Trial of Transanal Irrigation Versus Conservative Treatment in Patients With Low Anterior Resection Syndrome After Rectal Cancer Surgery. Ann Surg. 2023;277(1):30–7. Enriquez-Navascues JM, Labaka-Arteaga I, Aguirre-Allende I, Artola-Etxeberria M, Saralegui-Ansorena Y, Elorza-Echaniz G, et al. A randomized trial comparing transanal irrigation and percutaneous tibial nerve stimulation in the management of low anterior resection syndrome. Colorectal Dis. 2020;22(3):303–9. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-4084202\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":280373365,\"identity\":\"654ef482-8ebb-4656-841a-2a78742ccef6\",\"order_by\":0,\"name\":\"Hwa Ian 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17:07:11\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":40076,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eProportion of RALS and SLS participants stratified by surgical techniques.\\u003c/p\\u003e\\n\\u003cp\\u003eData presented in n (%)\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eRALS\\u003c/em\\u003e: Robotic-assisted laparoscopic surgery; \\u003cem\\u003eSLS\\u003c/em\\u003e:\\u003cem\\u003e \\u003c/em\\u003eStandard laparoscopic surgery; \\u003cem\\u003eDIE\\u003c/em\\u003e: Deep-infiltrative endometriosis; \\u003cem\\u003eRS\\u003c/em\\u003e: Rectal shaves; \\u003cem\\u003eDE\\u003c/em\\u003e: Discoid excision; \\u003cem\\u003eSR\\u003c/em\\u003e: Segmental 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condition characterized by the presence of endometrial-like tissue outside the uterus, affecting around 10% of women of childbearing age.(\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e) The ectopic endometrial tissue responds to hormonal fluctuations during the menstrual cycle, leading to pain, inflammation, and adhesion formation in affected organs.(\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e) Clinical presentations can vary, but women with endometriosis commonly present with pelvic pain, dysmenorrhea, and infertility.(\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e)\\u003c/p\\u003e \\u003cp\\u003eDeep-infiltrative endometriosis (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e) is defined as lesions with \\u0026ge;\\u0026thinsp;5 mm penetration into the peritoneum, or lesions that invade the muscularis propria of surrounding viscera, affecting more than 20% of women with said condition.(\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e) Among the known sites of DIE, bowel involvement is reported in 5\\u0026ndash;12% of women with endometriosis and can be associated with additional symptoms such as abdominal pain, hematochezia, and dyschezia.(\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e) A substantial subset of this, ranging from 70\\u0026ndash;93%, exhibits rectosigmoid involvement.(\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e)\\u003c/p\\u003e \\u003cp\\u003eThe primary approach for managing symptoms of bowel deep-infiltrating endometriosis (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e) involves medical therapy, including non-steroidal anti-inflammatory drugs, oral contraceptives, and progestins.(\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e) Once medical options have been exhausted, surgical removal has been considered as the next step in the treatment pathway, with standard laparoscopic surgery (SLS) being the current standard approach.(\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e) Various surgical techniques have been described for treating bowel DIE, including rectal shaves, discoid excisions, or segmental resections.\\u003c/p\\u003e \\u003cp\\u003eEach of the above techniques involves an increasing degree of surgical complexity, exposing patients to the risk of more significant complications. Therefore, the selection of the surgical technique depends on the extent, length and depth of bowel involvement and may vary depending on preferences and experience of the surgeon involved.(\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR10\\\" citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e)\\u003c/p\\u003e \\u003cp\\u003eRobot-assisted laparoscopic surgery (RALS) has been shown to be a viable alternative to conventional laparoscopy, providing technical advantages such as improved dexterity and ergonomics, increased range of motion, three-dimensional visualization, and elimination of tremors.(\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e) However, arguments for the feasibility of RALS over standard laparoscopy in the treatment of symptomatic BDIE remains limited in the literature, confounded with discrepancies in outcomes reporting.\\u003c/p\\u003e \\u003cp\\u003eThe main aim of this review is to collate and examine the existing data on RALS in the treatment of BDIE among symptomatic patients. This review aims to assess surgical procedural details, operative parameters, and postoperative outcomes to provide insights into the feasibility of the RALS approach for this population.\\u003c/p\\u003e \\u003cp\\u003eFurthermore, this review also aims to evaluate the developmental status of the RALS technique based on the IDEAL framework. The framework describes five stages \\u0026mdash; Idea, Development, Exploration, Assessment, and Long-term study \\u0026mdash; in the evaluation of emerging surgical techniques, determined by the types of studies already published on said technique.(\\u003cspan additionalcitationids=\\\"CR13\\\" citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e) Understanding the current developmental stage allows researchers to identify gaps in the current evidence base and guides the direction of future research in this space.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cp\\u003eThis review was designed according to PRISMA guidelines(\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e) and was submitted to the PROSPERO database, CRD42022308611. The search was last accessed in August 2023, of all publications in Medline, Embase, PubMed, and Cochrane Database, reporting on the outcomes of robot-assisted laparoscopic interventions for bowel DIE. Figure\\u0026nbsp;1 shows the key terms and Boolean operators used for the search in the title and abstract fields. A manual search for relevant studies was also carried out to identify additional studies.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eInclusion and exclusion criteria\\u003c/h2\\u003e \\u003cp\\u003ePrimary studies published up to August 2023 were considered for inclusion to ensure the relevance and timeliness of the findings. This review considered studies discussing RALS procedures for treating bowel DIE, including rectal shaves, discoid excisions, and segmental resections. These studies can either be non-comparative (RALS only) or comparative studies (RALS vs. SLS). The review population was restricted to symptomatic patients diagnosed with bowel DIE through clinical evaluations and/or imaging.\\u003c/p\\u003e \\u003cp\\u003eStudies with an emphasis on standard laparoscopic or laparotomy interventions only and those examining DIE which did not involve bowel were excluded from consideration. Additionally, literature reviews, conference abstracts, single-case reports, and studies not providing outcomes of interest were excluded.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec4\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStudy characteristics and outcomes of interest\\u003c/h2\\u003e \\u003cp\\u003eThe assessment of the study characteristics included variables such as authorship, publication year, geographical origin, study design, sample size, procedures of interest, and key findings. Furthermore, outcomes from each study were extracted using a prospectively designed collection sheet, encompassing technical details, intraoperative parameters, and postoperative outcomes.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec5\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eIDEAL staging and risk of bias assessment\\u003c/h2\\u003e \\u003cp\\u003eThe developmental stage of RALS for BDIE was determined using the IDEAL framework.(\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e) Since the studies were not written in the IDEAL format, the staging was decided based on the considerations put forward by Pennell et al.(\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e) The methodological quality and risk of bias in included studies were assessed using the Joanna-Briggs Institute (JBI) appraisal tools for case series(\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e) and cohort studies(\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e).\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec6\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eData extraction and statistical analysis\\u003c/h2\\u003e \\u003cp\\u003e Two independent reviewers (PN, NS) conducted title and abstract screening, full-text inclusion, and data extraction, with disputes settled with another reviewer (HO) if consensus was not reached. Data were summarized in a narrative synthesis and the Chi-squared test, Fisher\\u0026rsquo;s exact test, and Student\\u0026rsquo;s \\u003cem\\u003et\\u003c/em\\u003e-test were used for the comparison of categorical and numerical variables, where appropriate. In cases where variables were presented in the form of median/range, the mean/standard deviation were estimated employing methods outlined by Luo et al.(\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e) and Wan et al.(\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e). All reported p-values were two-sided, and a significant difference was noted when p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05. Statistical analysis was performed using commercially available software.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eThe steps for identifying studies for this review were summarized in the PRISMA diagram (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e). The initial search resulted in 223 studies. After the removal of duplicates, 192 studies underwent title and abstract screening, leaving 25 full-text studies to be reviewed. A further 14 were excluded for reasons highlighted in Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e, leaving 11 studies(\\u003cspan additionalcitationids=\\\"CR22 CR23 CR24 CR25 CR26 CR27 CR28 CR29 CR30\\\" citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e) to be included in the review.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStudy characteristics\\u003c/h2\\u003e \\u003cp\\u003eTable\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e compiles the data describing the studies\\u0026rsquo; characteristics. In summary, the study range spanned from 2012\\u0026ndash;2022. Among these studies, nine studies(\\u003cspan additionalcitationids=\\\"CR22 CR23 CR24 CR25 CR26 CR27 CR28\\\" citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e) were non-comparative case series focusing on RALS, whereas two studies(\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e) were comparative cohort studies. Overall, the studies included 527 participants, of which 451 received surgical treatment for BDIE (which may have also included concurrent removal of other sites of disease) - consisting of 368 RALS and 83 SLS participants. All participants who had treatment for DIE which did not involve bowel were excluded.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eCharacteristics of studies evaluating robotic surgery for the treatment of bowel endometriosis.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"9\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c9\\\" colnum=\\\"9\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAuthor\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYear\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eCountry\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eStudy Type\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eData collection\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eGroup\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eSample size\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eProcedures of interest\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eKey conclusion\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eErcoli et al.(\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2012\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eItaly\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eCS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eRetrospective\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eRALS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e22\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eRS, SR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eUse of RALS for bowel DIE treatment is feasible and safe.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCassini et al.(\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2013\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eItaly\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eCS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eRetrospective\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eRALS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e19\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eSR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eUse of RALS for bowel DIE treatment is feasible and safe.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCollinet et al.(\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2014\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eMultinational\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eCS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eRetrospective\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eRALS \\u003c/p\\u003e \\u003cp\\u003eOthers\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e92\\u003c/p\\u003e \\u003cp\\u003e72\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eRS, SR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eRALS is feasible in the surgical treatment of stage 4 DIE.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSiesto et al.(\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2014\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eItaly\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eCS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eRetrospective\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eRALS \\u003c/p\\u003e \\u003cp\\u003eOthers\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e42\\u003c/p\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eRS, SR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eUse of RALS for DIE is feasible and safe.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDiguisto et al.(\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2015\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eFrance\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eCS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eRetrospective\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eRALS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e28\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eRS, SR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eSR with RALS for treatment of DIE is associated with longer OT and LOS when compared to RS.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePellegrino et al.(\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2015\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eItaly\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eCS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eProspective\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eRALS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e25\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eRS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eRS with RALS for bowel DIE treatment is feasible and safe.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMorelli et al.(\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2016\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eItaly\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eCS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eProspective\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eRALS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e10\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eSR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eRALS for bowel DIE treatment is associated with low risks of complication and preservation of urinary and sexual function.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAbo et al.(\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2017\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eFrance\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eCS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eProspective\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eRALS \\u003c/p\\u003e \\u003cp\\u003eOthers\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e32\\u003c/p\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eRS, DE, SR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eUse of RALS for bowel DIE treatment is feasible and safe, but not superior to SLS.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGraham et al. (\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2019\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eUSA\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eCS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eRetrospective\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eRALS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e15\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eRS, SR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eUse of RALS for treatment of bowel DIE is feasible and safe.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRaimondo et al.(\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2021\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eItaly\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eCo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eProspective\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eRALS \\u003c/p\\u003e \\u003cp\\u003eSLS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e22\\u003c/p\\u003e \\u003cp\\u003e22\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eRS, DE, SR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eSimilar operative outcomes between RALS and SLS for bowel DIE treatment, except for longer operative room time.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFerrier et al.(\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2022\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eFrance\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eCo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eProspective\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eRALS\\u003c/p\\u003e \\u003cp\\u003eSLS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e61\\u003c/p\\u003e \\u003cp\\u003e61\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eRS, DE, SR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eRALS provides lower rates of intraoperative complications for DE or SR procedures when compared to SLS.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"9\\\"\\u003e\\u003csup\\u003ea\\u003c/sup\\u003e Belgium, England, France, Italy, Japan\\u003c/td\\u003e\\u003c/tr\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"9\\\"\\u003e\\u003csup\\u003eb\\u003c/sup\\u003e Indicate patient groups with endometrial involvement in sites other than bowel (e.g., bladder, ureter)\\u003c/td\\u003e\\u003c/tr\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"9\\\"\\u003e\\u003cem\\u003eCS\\u003c/em\\u003e: Case series; \\u003cem\\u003eCo\\u003c/em\\u003e: Cohort studies; \\u003cem\\u003eRALS\\u003c/em\\u003e: Robotic-assisted laparoscopic surgery; \\u003cem\\u003eSLS\\u003c/em\\u003e: Standard laparoscopic surgery; \\u003cem\\u003eRS\\u003c/em\\u003e: Rectal shaves; \\u003cem\\u003eDE\\u003c/em\\u003e: Discoid excision; \\u003cem\\u003eSR\\u003c/em\\u003e: Segmental resection; \\u003cem\\u003eOT\\u003c/em\\u003e: Operating time; \\u003cem\\u003eLOS\\u003c/em\\u003e: Length of hospital stay\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec9\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eSurgical procedural details\\u003c/h2\\u003e \\u003cp\\u003eNine studies reported the utilization of the Da Vinci System (Intuitive Surgical, Inc.) as their robotic platform (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e), with Ercoli et al likely to have also used this system in 2010. Where patient positioning was described, most were positioned in lithotomy, a configuration commonly used in gynecological, rectal, and urological procedures.(\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e) The depictions of port placements were mostly consistent with what has been described in existing literature.(\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e) For the two comparative studies,(\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e) the assignment of patients into either the RALS or SLS approach did not follow a formal randomization process, as it solely depended on the availability of the robotic theatre and equipment.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eSurgical system set-up and operative indication of studies evaluating robotic surgery for the treatment of bowel endometriosis.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"7\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eAuthor\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eRobotic system\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003ePatient position\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eNumber of ports and placement\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c7\\\" namest=\\\"c5\\\"\\u003e \\u003cp\\u003eEndometriotic lesion indications\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eRectal shaving\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eDiscoid excision\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eSegmental resection\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eErcoli et al.(\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e- Three 8mm robotic ports: umbilicus, R IF, L IF\\u003c/p\\u003e \\u003cp\\u003e- 12mm assistant port: R subcostal\\u003c/p\\u003e \\u003cp\\u003e- 5mm assistant port: L subcostal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eLesions limited to the bowel serosa\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eN/A\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eInfiltration into the rectal mucosa and the presence of more than one intestinal stricture\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCassini et al.(\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eda Vinci S/Si\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eModified lithotomy\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026minus;\\u0026thinsp;12mm camera port: umbilicus\\u003c/p\\u003e \\u003cp\\u003e- Two 8mm robotic ports: R IF, L IF\\u003c/p\\u003e \\u003cp\\u003e- 1mm stapler port: R subcostal\\u003c/p\\u003e \\u003cp\\u003e- 5mm additional port: NR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eN/A\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eN/A\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eLesions\\u0026thinsp;\\u0026gt;\\u0026thinsp;2cm infiltrating the bowel, or presence of multifocal lesions, or circumferential involvement of \\u0026gt;\\u0026thinsp;50%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCollinet et al.(\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eda Vinci S/Si\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e- Three to four robotic ports: NR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eN/A\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSiesto et al.(\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eda Vinci S\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eLithotomy\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026minus;\\u0026thinsp;12mm port: umbilicus\\u003c/p\\u003e \\u003cp\\u003e- Two 8mm robotic ports: R IF, L IF\\u003c/p\\u003e \\u003cp\\u003e- 10mm port: L subcostal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eLesions limited to the bowel serosa\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eN/A\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eLesions with infiltrations into layers deeper than the serosa (muscularis and mucosa layer)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDiguisto et al.(\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eda Vinci S\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eLithotomy\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eUnifocal lesions not involving the mucosal layer.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eN/A\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eMultifocal or extensive lesion with mucosal involvement\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePellegrino et al.(\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eda Vinci S\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eLithotomy\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026minus;\\u0026thinsp;12mm port: umbilical incision\\u003c/p\\u003e \\u003cp\\u003e- Two 8mm robotic ports: R IF, L IF\\u003c/p\\u003e \\u003cp\\u003e- 10mm port: L subcostal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eSuperficial lesions without full-thickness bowel wall infiltration\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eN/A\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eN/A\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMorelli et al.(\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eda Vinci Si\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eModified lithotomy\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026minus;\\u0026thinsp;12mm optical port: R of umbilicus\\u003c/p\\u003e \\u003cp\\u003e- Two 8mm robotic ports: R IF, L IF\\u003c/p\\u003e \\u003cp\\u003e- 12mm port: suprapubic\\u003c/p\\u003e \\u003cp\\u003e- 10mm port: R subcostal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eN/A\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eN/A\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eLesions involving the bowel muscularis layer\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAbo et al.(\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eda Vinci S/Si\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eModified lithotomy\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e- Three 8mm robotic ports: left of umbilicus, R IF, and L IF\\u003c/p\\u003e \\u003cp\\u003e- 10mm assistant port: R IF\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eMultifocal lesions causing severe bowel stenosis, or an area at risk of postoperative necrosis\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGraham et al. (\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eda Vinci Si\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eLithotomy\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026minus;\\u0026thinsp;12mm port: umbilicus\\u003c/p\\u003e \\u003cp\\u003e- Two 8mm ports: R IF and L IF\\u003c/p\\u003e \\u003cp\\u003e- 5mm assistant port: L subcostal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eLesions\\u0026thinsp;\\u0026lt;\\u0026thinsp;1cm or involving\\u0026thinsp;\\u0026lt;\\u0026thinsp;30% of the bowel circumference\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eN/A\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eLesions involving\\u0026thinsp;\\u0026gt;\\u0026thinsp;30% of the circumference of the bowel lumen\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRaimondo et al.(\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eda Vinci Si/Xi\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eAttempted first for all cases\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c7\\\" namest=\\\"c6\\\"\\u003e \\u003cp\\u003eIf macroscopic residual disease were observed after rectal shaving\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFerrier et al.(\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e- Three 8mm ports: umbilicus, R IF, L IF\\u003c/p\\u003e \\u003cp\\u003e- 5mm assistant port: NR\\u003c/p\\u003e \\u003cp\\u003e- 12mm port: R abdomen\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eSuperficial lesions without involvement of the mucosal layer\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eLesions involving the muscularis, \\u0026le; 3cm or \\u0026lt;90\\u0026deg; of the bowel circumference\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eMultifocal lesions\\u0026thinsp;\\u0026gt;\\u0026thinsp;3cm in length and involving \\u0026gt;90\\u0026deg; of the bowel circumference\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"7\\\"\\u003e\\u003cem\\u003eL\\u003c/em\\u003e: Left, \\u003cem\\u003eR\\u003c/em\\u003e: Right, \\u003cem\\u003eIF\\u003c/em\\u003e: Iliac fossa, \\u003cem\\u003eNR\\u003c/em\\u003e: Not reported, \\u003cem\\u003eN/A\\u003c/em\\u003e: Not applicable to the study\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eIn addition, all studies provided insight into at least one of the following techniques: rectal shaves, discoid excisions, and segmental resections. Most studies provided indications regarding the characteristics of endometrial lesions for each procedure (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e). However, the reporting of indications was not standardized, as each paper puts forward its own distinct criteria. As depicted in Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e, among the participants who underwent RALS and SLS for BDIE, 59% and 35% had shaves, 8% and 19% had discoid excisions, 33% and 42% had segmental resections.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec10\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eSurgeon Experience\\u003c/h2\\u003e \\u003cp\\u003eWhen interpreting the results from these studies, it is important to consider the surgical experience, particularly in the RALS group, as many of these studies may represent the surgical learning curve of this new technology.\\u003c/p\\u003e \\u003cp\\u003eThere was significant heterogeneity in the disclosure and experience of surgeons participating in these studies, as summarized in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e, but a trend towards more explicit disclosure of surgical robotic experience can be seen in more recent studies. As expected, all surgeons involved were also trained in laparoscopic surgery.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eSummary of Surgeon Experience in Performing RALS\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"3\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAuthor\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYear\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eSurgeon Experience\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eErcoli et al.(\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2012\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eUndisclosed\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCassini et al.(\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2013\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eUndisclosed.\\u003c/p\\u003e \\u003cp\\u003eLearning curve acknowledged in discussion.\\u003c/p\\u003e \\u003cp\\u003eHybrid laparoscopic approach taken in segmental resections, where standard laparoscopy used to mobilise and anastamose.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCollinet et al.(\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2014\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eGynaecologic surgeons trained in laparoscopic surgery.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSiesto et al.(\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2014\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eSingle surgeon with extensive experience in laparoscopic and abdominal gynaecological surgery\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDiguisto et al.(\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2015\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eUndisclosed\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePellegrino et al.(\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2015\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eSingle surgeon with extensive laparoscopic experience.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMorelli et al.(\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2016\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eExperienced Minimally Invasive Surgeons, performed\\u0026thinsp;\\u0026gt;\\u0026thinsp;900 cases.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAbo et al.(\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2017\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eSenior gynaecologic surgeon who could perform rectal shaves and ureterolysis.\\u003c/p\\u003e \\u003cp\\u003eOnly 35 of \\u0026gt;\\u0026thinsp;250 cases managed robotically in 3 years\\u003c/p\\u003e \\u003cp\\u003eLearning curve acknowledged in discussion.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGraham et al. (\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2019\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eSurgeons who had performed fellowships in robotic surgery, having performed\\u0026thinsp;\\u0026gt;\\u0026thinsp;500 robotic cases.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRaimondo et al.(\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2021\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eSenior surgeons trained in minimally invasive surgery, having performed\\u0026thinsp;\\u0026gt;\\u0026thinsp;25 robotic cases\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFerrier et al.(\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2022\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eExperienced gynaecological surgeons trained in minimally invasive surgery, who would perform both RALS and SLS\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eOperative and postoperative parameters\\u003c/h2\\u003e \\u003cp\\u003eThe operative and postoperative findings from each study were compiled in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e. Most studies reported these metrics using means and standard deviations (\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e) or medians and ranges. However, a few studies either omitted information on some outcomes or reported means/medians without corresponding SD/ranges, resulting in their exclusion from calculations done for Table\\u0026nbsp;\\u003cspan refid=\\\"Tab5\\\" class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e. Regarding patient characteristics, the groups exhibited comparable age and body mass index profiles (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab5\\\" class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e). The mean operating times was 227\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;104 in the RALS group and 171\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;76 min in the SLS group (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.01). For the remaining intraoperative metrics, there were no significant differences in blood loss, intraoperative complications, and laparotomy conversions.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eOperative and postoperative findings of studies evaluating robotic surgery for the treatment of bowel endometriosis.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"11\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c9\\\" colnum=\\\"9\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c10\\\" colnum=\\\"10\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c11\\\" colnum=\\\"11\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAuthor\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eGroup\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eSample size\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eAge (years)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eBMI (kg/m\\u003csup\\u003e2\\u003c/sup\\u003e)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eOperating time (min)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eBlood loss (\\u003cspan citationid=\\\"CR50\\\" class=\\\"CitationRef\\\"\\u003e50\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eLaparotomy conversion\\u003c/p\\u003e \\u003cp\\u003en (%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eIOC\\u003c/p\\u003e \\u003cp\\u003en (%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003ePOC\\u003c/p\\u003e \\u003cp\\u003en (%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003eLOS (days)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eErcoli et al.(\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eRALS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e22\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e38 [25\\u0026ndash;45]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e21 [17\\u0026ndash;25]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e370 [260\\u0026ndash;720]\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e280 [220\\u0026ndash;365]\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e100 [50\\u0026ndash;250]\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e200 [100\\u0026ndash;350]\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0 (0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0 (0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e1 (4.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e8 [6\\u0026ndash;10]\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e5 [4\\u0026ndash;7]\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCassini et al.(\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eRALS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e19\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e37 [25\\u0026ndash;45]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e21 [17\\u0026ndash;25]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e370 (250\\u0026ndash;720)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e150 [50\\u0026ndash;350]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0 (0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0 (0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e2 (\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e5 [3\\u0026ndash;8]\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCollinet et al.(\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eRALS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e92\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e34.1 (7.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e24.4 (8.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e188.2 (75.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e127.5 (293.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e1 (1.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e4 (4.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e4.2 (2.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSiesto et al.(\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eRALS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e42\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e34 [27.3\\u0026ndash;45.5]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e22.3 [17.2\\u0026ndash;41]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e200 [57\\u0026ndash;366]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e120 [100\\u0026ndash;1000]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e1 (2.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0 (0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e2 (4.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e3 [2\\u0026ndash;8]\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDiguisto et al.(\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eRALS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e28\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e34.1 (2.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e24.1 (1.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e190 (\\u003cspan citationid=\\\"CR51\\\" class=\\\"CitationRef\\\"\\u003e51\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e274 (\\u003cspan citationid=\\\"CR51\\\" class=\\\"CitationRef\\\"\\u003e51\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e1 (3.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e2 (7.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e4.9 (\\u003cspan citationid=\\\"CR51\\\" class=\\\"CitationRef\\\"\\u003e51\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePellegrino et al.(\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eRALS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e25\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e33.9 (6.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e21.2 (2.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e174 [75\\u0026ndash;300]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0 [0-100]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0 (0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e1 (\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e0 (0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e3 [2\\u0026ndash;4]\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMorelli et al.(\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eRALS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e10\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e36.5 [28\\u0026ndash;47]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e22.4 [18.2\\u0026ndash;25.9]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e280 [180\\u0026ndash;240]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e200 [100\\u0026ndash;400]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0 (0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0 (0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e1 (\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e6 [4\\u0026ndash;7]\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAbo et al.(\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eRALS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e32\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e36 (8.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e24.5 (5.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e207 (67)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0 (0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e3 (9.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGraham et al. (\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eRALS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e15\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e38 (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e29 (2.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e342 (42.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e283 (91.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0 (0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0 (0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e5 (\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e2 (1.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRaimondo et al.(\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eRALS\\u003c/p\\u003e \\u003cp\\u003eSLS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e22\\u003c/p\\u003e \\u003cp\\u003e22\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e38 (\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e)\\u003c/p\\u003e \\u003cp\\u003e36 (5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e24.5 [21\\u0026ndash;27]\\u003c/p\\u003e \\u003cp\\u003e22.5 [21\\u0026ndash;24]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e207 (79)\\u003c/p\\u003e \\u003cp\\u003e177 (63)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e184 (214)\\u003c/p\\u003e \\u003cp\\u003e144 (101)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e1 (4.5)\\u003c/p\\u003e \\u003cp\\u003e0 (0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e1 (4.5)\\u003c/p\\u003e \\u003cp\\u003e0 (0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e4 (\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e)\\u003c/p\\u003e \\u003cp\\u003e1 (4.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e8 (\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e)\\u003c/p\\u003e \\u003cp\\u003e6 (2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFerrier et al.(\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eRALS\\u003c/p\\u003e \\u003cp\\u003eSLS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e61\\u003c/p\\u003e \\u003cp\\u003e61\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e36 (\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e)\\u003c/p\\u003e \\u003cp\\u003e35 (7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e25 (\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e)\\u003c/p\\u003e \\u003cp\\u003e26 (8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e208 (90)\\u003c/p\\u003e \\u003cp\\u003e169 (81)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e161 (141)\\u003c/p\\u003e \\u003cp\\u003e188 (266)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e2 (3.3)\\u003c/p\\u003e \\u003cp\\u003e1 (1.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e2 (3.3)\\u003c/p\\u003e \\u003cp\\u003e6 (9.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e20 (\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e)\\u003c/p\\u003e \\u003cp\\u003e21 (34)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e7.5 (3.9)\\u003c/p\\u003e \\u003cp\\u003e7.8 (4.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"11\\\"\\u003eData are presented either in mean (\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e), median [range], or n (%)\\u003c/td\\u003e\\u003c/tr\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"11\\\"\\u003eErcoli et al. presented separate outcomes for two RALS subgroups: rectal shaves (n\\u0026thinsp;=\\u0026thinsp;10)\\u003csup\\u003ea\\u003c/sup\\u003e and segmental resections (n\\u0026thinsp;=\\u0026thinsp;12)\\u003csup\\u003eb\\u003c/sup\\u003e.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"11\\\"\\u003e\\u003cem\\u003eRALS\\u003c/em\\u003e: Robotic-assisted laparoscopic surgery; \\u003cem\\u003eSLS\\u003c/em\\u003e: Standard laparoscopic surgery; \\u003cem\\u003eBMI\\u003c/em\\u003e: Body mass index; \\u003cem\\u003eIOC\\u003c/em\\u003e: Intraoperative complications; \\u003cem\\u003ePOC\\u003c/em\\u003e: Postoperative complications; \\u003cem\\u003eNR\\u003c/em\\u003e: Not reported\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab5\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 5\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eComparative analysis of RALS and SLS patient groups.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eRALS\\u003c/p\\u003e \\u003cp\\u003e(\\u003cem\\u003en\\u0026thinsp;=\\u0026thinsp;368\\u003c/em\\u003e)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eSLS\\u003c/p\\u003e \\u003cp\\u003e(\\u003cem\\u003en\\u0026thinsp;=\\u0026thinsp;83\\u003c/em\\u003e)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003ep\\u003c/em\\u003e value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAge (years)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e35.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e35.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.52\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBMI (kg/m2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e24.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;5.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e25.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.33\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSurgical procedure\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.01\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRectal shaving\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e217 (59%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e29 (35%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDiscoid excision\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e30 (8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e19 (23%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSegmental resection\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e121 (33%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e35 (42%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOperative parameters\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOperating time (min)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e227\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;104\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e171\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;76\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.01\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eIntraoperative complications\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e10 (3.0%)\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e6 (7.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.07\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eConversion to laparotomy\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e6 (1.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1 (1.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.78\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBlood loss (\\u003cspan citationid=\\\"CR50\\\" class=\\\"CitationRef\\\"\\u003e50\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e155\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;207\\u003csup\\u003ec\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e176\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;234\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.46\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePost-operative outcomes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDuration of hospital stay (days)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.6\\u003csup\\u003ec\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e7.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.01\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGrade of complications (Clavien-Dindo Grade)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMajor complications (III-IV)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e15 (4.4%)\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3 (3.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMinor complications (I-II)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e22 (6.4%)\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e19 (22.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"4\\\"\\u003eData presented either in mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD or n (%)\\u003c/td\\u003e\\u003c/tr\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"4\\\"\\u003e\\u003csup\\u003ea\\u003c/sup\\u003e n\\u0026thinsp;=\\u0026thinsp;340; \\u003csup\\u003eb\\u003c/sup\\u003e n\\u0026thinsp;=\\u0026thinsp;336; \\u003csup\\u003ec\\u003c/sup\\u003e n\\u0026thinsp;=\\u0026thinsp;308; sample size varies due to studies excluded for not reporting outcomes\\u003c/td\\u003e\\u003c/tr\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"4\\\"\\u003e\\u003cem\\u003eRALS\\u003c/em\\u003e: Robotic-assisted laparoscopic surgery; \\u003cem\\u003eSLS\\u003c/em\\u003e: Standard laparoscopic surgery; \\u003cem\\u003eBMI\\u003c/em\\u003e: Body mass index.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eRegarding postoperative outcomes, the mean hospital stay was 5.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.6 days in the robotic group and 7.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.1 days in the standard group (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.01). Postoperative complications were stratified based on the Clavien-Dindo classification system to grade adverse events occurring after a surgical procedure.(\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e) The classification categorizes complications into grades ranging from I-V, in increasing severity. For the purposes of this study, complications were grouped into minor (I-II) and major (III-IV) complications, excluding Grade V (death) as it was not reported in any studies. Overall, major and minor complications occurred in 4.4% and 6.4% of cases in the robotic group, compared to 3.6% and 22.9% in the standard group.\\u003c/p\\u003e \\u003cp\\u003eWhen further broken down into specific types of complications, there was a higher rate of pelvic abscesses in the RALS group (n\\u0026thinsp;=\\u0026thinsp;6, 1.7%) compared to the SLS group (n\\u0026thinsp;=\\u0026thinsp;1, 1.2%). Anastamotic leak rate of 0.6% in the RALS group (n\\u0026thinsp;=\\u0026thinsp;2) lies within acceptable limits.\\u003c/p\\u003e \\u003cp\\u003eFrom a functional perspective, 4 studies reported significant improvements in dysmenorrhoea, dyspareunia, dyschezia and chronic pelvic pain within the RALS group at least 6 months post operatively(\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e) according to the 10 point VAS scale. Raimondo et al also found an equal improvement when compared to SLS(\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e). Morelli et al found an improvement in quality of life at 6 months(\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e) and Abo et al found improvements in bowel function up to 24 months post operatively(\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e). However, the heterogeneity of these measures precluded statistical analysis within the context of this systematic review.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eMinimally invasive laparoscopy has been the standard in the surgical treatment of endometriosis, including deep-infiltrative lesions of the bowel.(\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e) However, there are known constraints to standard laparoscopy, which include the loss of three-dimensional visualization, reduced degrees of movement, and the fulcrum effect.(\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e) The introduction of robotic surgical platforms aimed to address some of these limitations.(\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e) While meta-analyses(\\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e) established the feasibility of robotic surgery as an alternative to standard laparoscopy for treating endometriosis, none addressed it in the context of bowel DIE. A review by Hur and Falcone(\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e) had a similar focus, providing a general overview of the role of RALS in bowel endometriosis. However, this present study placed an additional emphasis on conducting a comprehensive review in accordance with the PRISMA guidelines and comparative analysis of data using descriptive statistics.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec13\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eChoice of surgical techniques using RALS\\u003c/h2\\u003e \\u003cp\\u003eSignificant differences in the choice of surgical techniques emerged between RALS and SLS, with rectal shaves more frequently utilized with RALS (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab5\\\" class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e). The higher prevalence of shaves in the robotic group could be attributed to the benefits associated with robot-assisted surgery, which offers better vision to aid in assessment of disease depth, allowing surgeons to perform complete excisions with clear margins with rectal shaves, and improved dexterity enabling easier and secure suturing within the confines of the pelvis. When more extensive resection is performed, the technical complexities involved may diminish some of the advantages offered by robotic surgery.\\u003c/p\\u003e \\u003cp\\u003eAnother factor to consider is the inherent variation of surgical indications described in the studies. The choice of technique itself is dependent upon several factors, including the extent and depth of bowel involvement.(\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR10\\\" citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e). This inherent variability in decision-making reflects the multitude of factors which influence the personalized nature of treatment decisions.\\u003c/p\\u003e \\u003cp\\u003eThe decision to perform segmental resections balance a lower recurrence risk against the increased risk of major complications, particularly anastamotic leak and requirement for stoma. In the cohort of patients reviewed, 2 anastamotic leaks were identified, both within the RALS group. This could be explained by a number of factors. Sampling bias is likely to have played a significant role in this finding, particularly in the SLS group, where only 35 patients underwent segmental resection. A large multicenter meta-analysis, including 1622 patients puts this risk at 1.9%(\\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e). Comparatively the rate of 0.6% in the RALS group is within acceptable limits. Furthermore, as these cohort studies are unblinded, selection bias may be present, where more complex cases were undertaken when the robotic system is available, as acknowledged by Graham et al(\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e),.\\u003c/p\\u003e \\u003cp\\u003eHowever, the increased prevalence of segmental resections within the SLS cohort itself introduces a potential confounding variable, given its association with prolonged surgical duration and an increased risk of postoperative complications.(\\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e). These factors can naturally influence other surgical outcomes, such as recovery times and complication rates.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec14\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eOperative and postoperative outcomes of RALS\\u003c/h2\\u003e \\u003cp\\u003eThis review suggests that RALS is feasible and safe for treating symptomatic patients with bowel deep-infiltrating endometriosis, leading to minimal surgical complications and infrequent conversion to laparotomy. Additionally, there is a trend towards fewer intraoperative complications in the robotic group, although this has not reached clinical significance (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab5\\\" class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e). One study(\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e) even associates RALS with the preservation of urinary function and sexual well-being up to a year post-surgery. Intraoperative blood loss, another important metric influencing surgical complications, was likewise found to exhibit no significant differences between the groups. The studies included in this review indicate that RALS confers at least an equal benefit in terms of resolution of preoperative symptoms to SLS, but true statistical analysis was not possible due to the heterogeneity of the data.\\u003c/p\\u003e \\u003cp\\u003eHowever, when compared to standard laparoscopy, RALS is associated with significantly longer operating duration, consistent with other reports within the existing literature. Numerous reviews and randomized trials have explored the differences in operating times between RALS and SLS for various subsets of endometriosis patients.(\\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e43\\u003c/span\\u003e) While many of these studies reached similar conclusions regarding extended operating times with RALS, there were notable variations in the reported data. Factors contributing to these variations include the selective exclusion of patients with bowel involvement or inclusions of superficial endometriosis in these studies, leading to shorter reported operating times. This complexity underscores the importance of considering specific study contexts and inclusion criteria when interpreting data on operating times.\\u003c/p\\u003e \\u003cp\\u003ePostoperatively, the robotic group exhibits a shorter hospital stay and differences in postoperative complication rates, with a slightly higher rate of major complications and a lower rate of minor complications (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab5\\\" class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e). When compared to major laparoscopic studies, with postoperative major complication rates of 2.5% the rate of major complications in this study (4.4% in RALS and 3.6% in SLS) appears high. However, this could be attributable to a smaller sample size (368 and 83 vs 4721)(\\u003cspan citationid=\\\"CR44\\\" class=\\\"CitationRef\\\"\\u003e44\\u003c/span\\u003e). Furthermore, many of these studies acknowledged the learning curve experienced in performing robotic surgery, compared to their significant laparoscopic experience.\\u003c/p\\u003e \\u003cp\\u003eIn addition, it is important to note that the observational nature of these included studies inherently provides evidence of lower quality compared to RCTs.(\\u003cspan citationid=\\\"CR45\\\" class=\\\"CitationRef\\\"\\u003e45\\u003c/span\\u003e) These studies, due to the lack of controlled interventions, have limitations in their ability to establish causal relationships.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec15\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eTranslation into clinical practice\\u003c/h2\\u003e \\u003cp\\u003eProlonged operating time can largely be attributed to the unique characteristics of robotic surgery, with additional time required for tasks such as docking, robot positioning, and troubleshooting technical issues.(\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e) Previous research(\\u003cspan citationid=\\\"CR46\\\" class=\\\"CitationRef\\\"\\u003e46\\u003c/span\\u003e) describing surgical treatments of advanced endometriosis had shown that longer durations of surgery potentially increase the physiological stress on the patient, adversely affecting recovery times and postoperative outcomes.\\u003c/p\\u003e \\u003cp\\u003eAnother factor to consider is that operating room time is a valuable resource in healthcare. Prolonged surgeries consume more resources, including personnel, equipment, and facilities \\u0026ndash; on top of the costs incurred for implementing and maintaining the robotic equipment.(\\u003cspan citationid=\\\"CR47\\\" class=\\\"CitationRef\\\"\\u003e47\\u003c/span\\u003e) Consequently, this can result in higher immediate costs, which may be offset by the significantly shorter length of stay and lower rates of surgical complications. Furthermore, as the use of the robotic systems mature, it is expected that the operating time will decrease as the learning curve is overcome by both the surgeons and their supporting theatre staff.\\u003c/p\\u003e \\u003cp\\u003eIn summary, from a practical perspective, the availability of a robotic system can pose a barrier to the adoption of RALS due to its high start-up costs. Nevertheless, as demonstrated in this review, there are potential benefits to using RALS which can only be fully understood through increased availability and utilization of robotic operating systems within the healthcare system. It is important to note that comprehensive cost-benefit analyses specific to RALS in treating bowel DIE have been lacking thus far. Future research is essential to provide additional perspectives on the medico-economic implications associated with RALS.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec16\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eIDEAL staging of RALS for bowel DIE\\u003c/h2\\u003e \\u003cp\\u003e The evaluation of RALS for the treatment of bowel DIE reveals a dynamic landscape of evolving surgical techniques and research methodologies as evidenced by the studies highlighted in this review. In the early 2010s, studies(\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e) on this topic predominantly featured single-centre retrospective case series, indicative of the IDEAL Stage 2a (Development).(\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e) These studies sought to establish the viability and safety of RALS for bowel DIE, along with building consensus on the technical aspects of the procedure and sharing early clinical experiences.\\u003c/p\\u003e \\u003cp\\u003eHowever, recent papers(\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e) on the technique have transitioned into Stage 2b (Exploration), characterized by prospective cohort studies. This evolution reflects the maturity of the technique, supported by robust findings indicating its feasibility and safety. Studies directly comparing RALS against standard laparoscopy are emerging, shedding light on the learning curves associated with RALS and highlighting the necessity for RCTs to provide more definitive evidence. Based on these considerations, the overall staging of RALS for bowel DIE can be classified as the endpoint of Stage 2b. This signifies a consensus on the maturity of the technique, favourable clinical outcomes, and an understanding of desirable outcome measures.(\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e)\\u003c/p\\u003e \\u003cp\\u003eLooking ahead, it is imperative that multicentre RCTs be undertaken to provide higher-quality evidence to investigate the comparative effectiveness of RALS versus SLS. Notably, the upcoming ROBEndo RCT(\\u003cspan citationid=\\\"CR48\\\" class=\\\"CitationRef\\\"\\u003e48\\u003c/span\\u003e) represents a promising step in this direction and holds the potential to influence future research in this field.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec17\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eLimitations\\u003c/h2\\u003e \\u003cp\\u003eIt is important to recognize that like any literature review, this analysis may be susceptible to evidence selection, reporting, and publication biases, as well as the inherent biases of the studies previously mentioned.(\\u003cspan citationid=\\\"CR49\\\" class=\\\"CitationRef\\\"\\u003e49\\u003c/span\\u003e) To limit the sources of these biases, several measures were put in place. Firstly, two independent reviewers performed a thorough assessment of the methodology and risk of bias in all the studies (Tables\\u0026nbsp;\\u003cspan refid=\\\"Tab6\\\" class=\\\"InternalRef\\\"\\u003e6\\u003c/span\\u003e and \\u003cspan refid=\\\"Tab7\\\" class=\\\"InternalRef\\\"\\u003e7\\u003c/span\\u003e). Additionally, strict adherence to PRISMA guidelines ensured a structured review and reporting process.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab6\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 6\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eJBI checklist for case series(\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"10\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c9\\\" colnum=\\\"9\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c10\\\" colnum=\\\"10\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eErcoli et al.\\u003csup\\u003e20\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eCassini et al.\\u003csup\\u003e21\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eCollinet et al.\\u003csup\\u003e22\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eSiesto et al.\\u003csup\\u003e23\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eDiguisto et al.\\u003csup\\u003e24\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ePellegrino et al.\\u003csup\\u003e25\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eMorelli et al.\\u003csup\\u003e26\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eAbo et al.\\u003csup\\u003e27\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eGraham et al. \\u003csup\\u003e28\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWere there clear criteria for inclusion in the case series?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWas the condition measured in a standard, reliable way for all participants included in the case series?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWere valid methods used for identification of the condition for all participants included in the case series?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDid the case series have consecutive inclusion of participants?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eUnk.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDid the case series have complete inclusion of participants?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eUnk.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWas there clear reporting of the demographics of the participants in the study?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWas there clear reporting of clinical information of the participants?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWere the outcomes or follow up results of cases clearly reported?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWas there clear reporting of the presenting site(s)/clinic(s) demographic information?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eN\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eN\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eN\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eN\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eN\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eN\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eN\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eN\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eN\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWas statistical analysis appropriate?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"10\\\"\\u003e\\u003cem\\u003eY\\u003c/em\\u003e: Yes; \\u003cem\\u003eN\\u003c/em\\u003e: No; \\u003cem\\u003eN/A\\u003c/em\\u003e: Not applicable to study; \\u003cem\\u003eUnk\\u003c/em\\u003e: Unknown\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab7\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 7\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eJBI checklist for cohort studies(\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"3\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eRaimondo et al.\\u003csup\\u003e29\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eFerrier et al.\\u003csup\\u003e30\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWere the two groups similar and recruited from the same population?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWere the exposures measured similarly to assign people to both exposed and unexposed groups?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWas the exposure measured in a valid and reliable way?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWere the confounding factors identified?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWere strategies to deal with confounding factors stated?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWere the groups/participants free of the outcome at the start of the study (or at the moment of exposure)?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eN/A\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eN/A\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWere the outcomes measured in a valid and reliable way?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWas the follow up time reported and sufficient to be long enough for outcomes to occur?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWas follow up complete, and if not, were the reasons to loss to follow up described and explored?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWere strategies to address incomplete follow up utilized?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eN/A\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eN/A\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWas appropriate statistical analysis used?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eY\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"3\\\"\\u003e\\u003cem\\u003eY\\u003c/em\\u003e: Yes; \\u003cem\\u003eN\\u003c/em\\u003e: No; \\u003cem\\u003eN/A\\u003c/em\\u003e: Not applicable to study\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eHowever, the nature of the included studies inherently provides lower-quality evidence compared to prospective RCTs.(\\u003cspan citationid=\\\"CR45\\\" class=\\\"CitationRef\\\"\\u003e45\\u003c/span\\u003e) While these studies offer valuable insights into real-world clinical practices, the observational nature and lack of controlled interventions limit their ability to establish definitive causal relationships. Furthermore, their vulnerability to confounders presents a concern, given that this review cannot address all potential factors that might influence the outcomes, such as the surgeons\\u0026rsquo; learning curve for RALS. Lastly, heterogeneity in outcome reporting measures, alongside the lack of studies reporting relevant outcomes such as urinary and sexual function, cost analysis, and fertility, prevents a more comprehensive assessment from being performed.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eRobotic-assisted laparoscopic surgery has emerged as an alternative to conventional laparoscopy in the context of deep-infiltrative endometriosis involving the bowel. Our review suggests that RALS offers potential benefits of reduced postoperative hospital stay and a trend towards lower intraoperative complications, with longer operating times. As surgeons and techniques mature, well-designed randomized studies are imperative to further define the safety and efficacy of RALS in bowel endometriosis, aligning with an IDEAL framework stage of 2b. Future studies should address the impact of the learning curve of robotic surgery, potential differences in resection margins and functional outcomes in DIE, as well compare each technique; rectal shave, discoid excision and segmental resection, to define the advantages and disadvantages of each system.\\u003c/p\\u003e \"},{\"header\":\"Declarations\",\"content\":\"\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003eConceptualisation - UM, CP, CF, HMMethodology - SWr, DN, CP, NS, PN, HOData Curation, Investigation and Formal Analysis - NS, PN, HOValidation - HM, HO, CF, DP, SWaSupervision - UM, JM, DP, SWa, CF, HMWriting - Original Draft, Visualisation - PN, HO, NSResources - UM, DP, HMProject Administration - SWr, NS, PN, DNWriting - Review \\u0026amp; Editing - SWa, HM, CF, HOAll authors reviewed and agree with contents of the manuscript\\u003c/p\\u003e\\u003cp\\u003eConflict of Interest : None\\u003c/p\\u003e\\n\\u003cp\\u003eThe datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.\\u003c/p\\u003e\\n\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eAllgayer H, Dietrich CF, Rohde W, Koch GF, Tuschhoff T. Prospective comparison of short- and long-term effects of pelvic floor exercise/biofeedback training in patients with fecal incontinence after surgery plus irradiation versus surgery alone for colorectal cancer: clinical, functional and endoscopic/endosonographic findings. Scand J Gastroenterol. 2005;40(10):1168\\u0026ndash;75.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eTaylor HS, Kotlyar AM, Flores VA. Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. The Lancet. 2021;397(10276):839\\u0026ndash;52.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eChapron C, Marcellin L, Borghese B, Santulli P. Rethinking mechanisms, diagnosis and management of endometriosis. Nature Reviews Endocrinology. 2019;15(11):666\\u0026ndash;82.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAlimi Y, Iwanaga J, Loukas M, Tubbs RS. The Clinical Anatomy of Endometriosis: A Review. Cureus. 2018;10(9):e3361.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eDara\\u0026iuml; E, Cohen J, Ballester M. Colorectal endometriosis and fertility. European Journal of Obstetrics \\u0026amp; Gynecology and Reproductive Biology. 2017;209:86\\u0026ndash;94.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMeuleman C, Tomassetti C, D'Hoore A, Van Cleynenbreugel B, Penninckx F, Vergote I, et al. Surgical treatment of deeply infiltrating endometriosis with colorectal involvement. Hum Reprod Update. 2011;17(3):311\\u0026ndash;26.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWills HJ, Reid GD, Cooper MJ, Morgan M. Fertility and pain outcomes following laparoscopic segmental bowel resection for colorectal endometriosis: a review. Aust N Z J Obstet Gynaecol. 2008;48(3):292\\u0026ndash;5.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eVercellini P, Crosignani PG, Somigliana E, Berlanda N, Barbara G, Fedele L. Medical treatment for rectovaginal endometriosis: what is the evidence? Hum Reprod. 2009;24(10):2504\\u0026ndash;14.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBecker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L, et al. ESHRE guideline: endometriosis. Hum Reprod Open. 2022;2022(2):hoac009.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eDonnez O, Roman H. Choosing the right surgical technique for deep endometriosis: shaving, disc excision, or bowel resection? Fertil Steril. 2017;108(6):931\\u0026ndash;42.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHur C, Falcone T. Robotic treatment of bowel endometriosis. Best Pract Res Clin Obstet Gynaecol. 2021;71:129\\u0026ndash;43.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMcCulloch P, Cook JA, Altman DG, Heneghan C, Diener MK. IDEAL framework for surgical innovation 1: the idea and development stages. BMJ: British Medical Journal. 2013;346:f3012.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHirst A, Philippou Y, Blazeby J, Campbell B, Campbell M, Feinberg J, et al. No Surgical Innovation Without Evaluation: Evolution and Further Development of the IDEAL Framework and Recommendations. Ann Surg. 2019;269(2):211\\u0026ndash;20.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMcCulloch P, Altman DG, Campbell WB, Flum DR, Glasziou P, Marshall JC, et al. No surgical innovation without evaluation: the IDEAL recommendations. 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Robotic treatment of colorectal endometriosis: technique, feasibility and short-term results. Hum Reprod. 2012;27(3):722\\u0026ndash;6.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCassini D, Cerullo G, Miccini M, Manoochehri F, Ercoli A, Baldazzi G. Robotic Hybrid Technique in Rectal Surgery for Deep Pelvic Endometriosis. Surgical Innovation. 2013;21(1):52\\u0026ndash;8.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCollinet P, Leguevaque P, Neme RM, Cela V, Barton-Smith P, Hebert T, et al. Robot-assisted laparoscopy for deep infiltrating endometriosis: international multicentric retrospective study. Surg Endosc. 2014;28(8):2474\\u0026ndash;9.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSiesto G, Ieda N, Rosati R, Vitobello D. Robotic surgery for deep endometriosis: a paradigm shift. Int J Med Robot. 2014;10(2):140\\u0026ndash;6.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eDiguisto C, H\\u0026eacute;bert T, Paternotte J, Kellal I, Marret H, Ouldamer L, et al. [Robotic assisted laparoscopy: comparison of segmentary colorectal resection and shaving for colorectal endometriosis]. Gynecol Obstet Fertil. 2015;43(4):266\\u0026ndash;70.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003ePellegrino A, Damiani GR, Trio C, Faccioli P, Croce P, Tagliabue F, et al. Robotic Shaving Technique in 25 Patients Affected by Deep Infiltrating Endometriosis of the Rectovaginal Space. Journal of Minimally Invasive Gynecology. 2015;22(7):1287\\u0026ndash;92.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMorelli L, Perutelli A, Palmeri M, Guadagni S, Mariniello MD, Di Franco G, et al. 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Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e\\u003c/span\\u003e\\u003cspan address=\\\"http://www.ncbi.nlm.nih.gov/books/NBK513320/\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGerber LH, Hodsdon B, Comis LE, Chan L, Gallin JI, McGarvey CL, 3rd. A Brief Historical Perspective of Cancer Rehabilitation and Contributions From the National Institutes of Health. PM R. 2017;9(9S2):S297-S304.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eDindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205\\u0026ndash;13.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKatayama H, Kurokawa Y, Nakamura K, Ito H, Kanemitsu Y, Masuda N, et al. Extended Clavien-Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today. 2016;46(6):668\\u0026ndash;85.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCatenacci M, Flyckt RL, Falcone T. Robotics in reproductive surgery: Strengths and limitations. Placenta. 2011;32:S232-S7.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eChen CCG, Falcone T. Robotic gynecologic surgery: Past, present, and future. Clinical Obstetrics and Gynecology. 2009;52(3):335\\u0026ndash;43.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eChen S-H, Li Z-A, Du X-P. Robot-assisted versus conventional laparoscopic surgery in the treatment of advanced stage endometriosis: a meta-analysis. CEOG. 2016;43(3):422\\u0026ndash;6.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eRestaino S, Mereu L, Finelli A, Spina MR, Marini G, Catena U, et al. Robotic surgery vs laparoscopic surgery in patients with diagnosis of endometriosis: a systematic review and meta-analysis. J Robot Surg. 2020;14(5):687\\u0026ndash;94.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBendifallah SP, Anne; Vesale, Elie; Moawad, Gaby; Dara\\u0026iuml;, Emile; Roman, Horace. Surgical outcomes after colorectal surgery for endometriosis: Systematic Review and Meta-Analysis. Journal of Minimally Invasive Gynaecology. 2021;28(3):453\\u0026ndash;66.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eDara\\u0026iuml; E, Bazot M, Rouzier R, Houry S, Dubernard G. Outcome of laparoscopic colorectal resection for endometriosis. Curr Opin Obstet Gynecol. 2007;19(4):308\\u0026ndash;13.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eParra RS, Val\\u0026eacute;rio FP, Zanardi JVC, Feitosa MR, Camargo HP, F\\u0026eacute;res O. Postoperative Complications and Stoma Rates After Laparoscopic Resection of Deep Infiltrating Endometriosis with Bowel Involvement. Rev Bras Ginecol Obstet. 2022;44(11):1040\\u0026ndash;6.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSoto E, Luu TH, Liu X, Magrina JF, Wasson MN, Einarsson JI, et al. Laparoscopy vs. Robotic Surgery for Endometriosis (LAROSE): a multicenter, randomized, controlled trial. Fertil Steril. 2017;107(4):996\\u0026ndash;1002.e3.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eByrne D, Curnow T, Smith P, Cutner A, Saridogan E, Clark TJ, et al. Laparoscopic excision of deep rectovaginal endometriosis in BSGE endometriosis centres: a multicentre prospective cohort study. BMJ Open. 2018;8(4):e018924.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGilmartin-Thomas JF, Liew D, Hopper I. Observational studies and their utility for practice. Aust Prescr. 2018;41(3):82\\u0026ndash;5.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMagrina JF, Espada M, Kho RM, Cetta R, Chang YH, Magtibay PM. Surgical Excision of Advanced Endometriosis: Perioperative Outcomes and Impacting Factors. J Minim Invasive Gynecol. 2015;22(6):944\\u0026ndash;50.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMcBride K, Steffens D, Stanislaus C, Solomon M, Anderson T, Thanigasalam R, et al. Detailed cost of robotic-assisted surgery in the Australian public health sector: from implementation to a multi-specialty caseload. BMC Health Services Research. 2021;21(1):108.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eTerho AM, M\\u0026auml;kel\\u0026auml;-Kaikkonen J, Ohtonen P, Uimari O, Puhto T, Rautio T, et al. Robotic versus laparoscopic surgery for severe deep endometriosis: protocol for a randomised controlled trial (ROBEndo trial). BMJ Open. 2022;12(7):e063572.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eDrucker AM, Fleming P, Chan A-W. Research Techniques Made Simple: Assessing Risk of Bias in Systematic Reviews. Journal of Investigative Dermatology. 2016;136(11):e109-e14.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003ePieniowski EHA BC, Nordenvall CAM, Westberg KS, Johar AM, Tumlin Ekelund SF, Larsson KR, Pekkari KJ, Jansson Palmer GC, Lagergren P, Abraham-Nordling M. A Randomized Controlled Clinical Trial of Transanal Irrigation Versus Conservative Treatment in Patients With Low Anterior Resection Syndrome After Rectal Cancer Surgery. Ann Surg. 2023;277(1):30\\u0026ndash;7.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eEnriquez-Navascues JM, Labaka-Arteaga I, Aguirre-Allende I, Artola-Etxeberria M, Saralegui-Ansorena Y, Elorza-Echaniz G, et al. A randomized trial comparing transanal irrigation and percutaneous tibial nerve stimulation in the management of low anterior resection syndrome. Colorectal Dis. 2020;22(3):303\\u0026ndash;9.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Endometriosis, Robotic Surgery\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-4084202/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-4084202/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eAims\\u003c/h2\\u003e \\u003cp\\u003eThis review aims to evaluate the feasibility of robot-assisted laparoscopic surgery (RALS) as an alternative to standard laparoscopic surgery (SLS) for the treatment of bowel deep-infiltrative endometriosis (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e). Additionally, it aims to provide guidance for future study design, by gaining insight into the current state of research, in accordance with the IDEAL framework.\\u003c/p\\u003e\\u003ch2\\u003eMethod\\u003c/h2\\u003e \\u003cp\\u003e A systematic review was conducted to identify relevant studies on RALS for bowel deep infiltrating endometriosis (BDIE) in Medline, Embase, Cochrane Library, and PubMed databases up to August 2023 and reported in keeping with PRISMA guidelines, The study was registered with PROSPERO Registration: CRD42022308611\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003e11 primary studies were identified, encompassing 364 RALS patients and 83 SLS patients, from which surgical details, operative and postoperative outcomes were extracted. In the RALS group, mean operating time was longer (235\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;112 min) than in the standard laparoscopy group (171\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;76 min) (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.01). However, RALS resulted in fewer postoperative complications (15.3%) compared to standard laparoscopy (26.5%). Patients in the RALS group experienced a shorter hospital stay (5.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.5 days vs. 7.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.1 days) (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.01). Research evidence for RALS in BDIE is at an IDEAL Stage 2B of development.\\u003c/p\\u003e\\u003ch2\\u003eConclusion\\u003c/h2\\u003e \\u003cp\\u003eRALS is a safe and feasible alternative to standard laparoscopy for bowel endometriosis treatment, potentially improving rates of intraoperative and overall postoperative complications despite longer operating times.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Role of robot-assisted laparoscopy in deep-infiltrating endometriosis with bowel involvement: a systematic review and application of the IDEAL framework\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-03-18 17:07:06\",\"doi\":\"10.21203/rs.3.rs-4084202/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"06402be7-8e67-463d-9b06-e7799a6835f2\",\"owner\":[],\"postedDate\":\"March 18th, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2024-04-03T08:31:34+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2024-03-18 17:07:06\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-4084202\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-4084202\",\"identity\":\"rs-4084202\",\"version\":[\"v1\"]},\"buildId\":\"WvIrzKhiLBfengagbw6Ux\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC0","license_restricted":false}