Robotic Compared With Conventional Laparoscopy for Treatment of Severe Endometriosis

INTRODUCTION: To determine outcome differences in patients undergoing robotic-assisted compared with conventional laparoscopy for advanced-stage endometriosis. METHODS: Cases were collected from our prospectively maintained computerized database of robotic-assisted and conventional laparoscopic surgical treatments for endometriosis performed by one surgeon experienced in both techniques. Included were all patients treated between July 2009 and October 2012 for endometriosis stage III or IV (American Society for Reproductive Medicine criteria). Compared between robotic-assisted laparoscopic surgery and conventional laparoscopic surgery groups were median age, body mass index, race, extent of surgery, median estimated blood loss, operating room time, length of stay, and intraoperative and postoperative complications. For continuous variables, medians and first and third quartiles were calculated; medians were compared with the Wilcoxon rank-sum test. Distributions of categorical variables were compared with χ2 or Fisher's exact tests. All analyses were two-sided with P<.05 considered significant. RESULTS: Included were 86 conventional laparoscopic surgery and 32 robotic-assisted laparoscopic surgery cases. Compared with the patients undergoing conventional laparoscopic surgery, those who underwent robotic-assisted laparoscopic surgery had a higher body mass index (27.36 kg/m2 [23.90–34.09 kg/m2] compared with 24.53 kg/m2 [22.27–26.96 kg/m2]; P<.008; Table 1) and operating room time (250.50 [176–328.50] compared with 173.50 [123–237] minutes; P<.001; Table 2). No significant differences were noted between the robotic-assisted laparoscopic surgery and conventional laparoscopic surgery groups in age, race, hysterectomy rate, estimated blood loss, length of stay, or in rates of intraoperative or postoperative complications.CONCLUSIONS: Despite a higher mean operating room time in the robotic-assisted laparoscopic surgery group, implementation of this new technology might allow a safe minimally invasive surgical approach for obese patients with all other clinical outcomes comparable to those in nonobese patients undergoing conventional laparoscopic surgery.