Anatomic Restoration Through Robotic Surgery in Endometriosis-Associated Infertility

INTRODUCTION: Endometriosis is a leading cause of infertility and pelvic pain, with deep infiltrating disease often distorting pelvic anatomy and compromising reproductive potential. Surgical excision is a critical component of management for patients desiring fertility restoration. However, advanced disease presents challenges, including dense adhesions, altered anatomy, and risks of vascular compromise to the adnexa. Robotic surgery offers enhanced 3D visualization, wristed instrumentation, and stable retraction that facilitate precise dissection and anatomic restoration in complex, fertility-sparing cases. OBJECTIVE: The objective of this video is to demonstrate robotic techniques that enhance efficiency, safety, and anatomic restoration in fertility-sparing surgery for advanced endometriosis. METHODS: This video illustrates the application of robotic surgical principles in fertility-preserving resection of deep endometriosis. Strategies focus on optimizing visualization, precise tissue handling, and systematic resection to restore normal anatomy. Techniques include ureterolysis, en-bloc peritonectomy, and excision of rectovaginal implants, emphasizing efficiency, safety, and preservation of reproductive potential. RESULTS: This video demonstrates robotic techniques for fertility-sparing resection of advanced endometriosis, emphasizing treatment of fertility-limiting lesions and restoration of adnexal anatomy while preserving vascular integrity, with distinct advantages in visualization, dissection, and efficiency compared with conventional laparoscopy. CONCLUSIONS: Robotic-assisted surgery represents a valuable approach to fertility-preserving management of advanced endometriosis. The techniques demonstrated emphasize platform-specific strategies-enhanced visualization, stable retraction, and precise dissection-that support safe and efficient restoration of pelvic anatomy. By highlighting these nuances, the video underscores how robotic surgery can complement established laparoscopic principles while offering unique advantages for patients desiring fertility preservation.