Current status of robot-assisted surgery implementation in endometriosis centers: an international multicentric cross-sectional study

Harald Krentel, Nicolas Samartzis, Dimitrios Rafail Kalaitzopoulos, A. Constantin, Alin Stefan Constantin, Karl-Werner Schweppe, Julian Matthias Metzler, Dimitrios Andrikos, Isabell Witzel, Rudy Leon De Wilde, Jörg Keckstein, J. Keckstein, Laurin Burla
Archives of gynecology and obstetrics · 2025 · vol. 312(3) , pp. 871–883 · doi:10.1007/s00404-025-08081-9 · PMID:40506623 · PMC12374906 · W4411231076
article OA: gold CC0
📄 Open PDF View on OpenAlex View on PubMed View at publisher
⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

Robot-assisted surgery is used in about half of participating endometriosis centers, offering advantages in precision and complex cases, though cost remains a barrier.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This international multicentric cross-sectional survey studied how robot-assisted surgery (RAS) is implemented in certified endometriosis centers in Austria, the Czech Republic, Germany, and Switzerland, using an anonymous 47-question branching online survey administered to senior members of participating centers. Among 64 of 97 contacted centers (66%), RAS was available in 48.4% of all participating centers (used for endometriosis in 60.8% of centers with access to a surgical robot), with reported advantages including precision, instrument mobility, and visualization, and perceived preference over conventional laparoscopic surgery (CLS) particularly in multidisciplinary cases, overweight patients, and deep endometriosis, with specific anatomic indications cited using #Enzian classification. The study’s key caveat is that outcomes were based on center ratings rather than comparative patient-level data, and barriers such as costs and lack of scientific evidence were prominent for centers without robot access. This paper is centrally about endometriosis — it provides a real-world overview of robotic-assisted surgery uptake and perceived advantages/barriers in certified endometriosis centers, with particular focus on deep endometriosis.

Read from the paper's body, not the abstract. Not a substitute for reading the paper. No clinical advice. How this works

Abstract

PURPOSE: The surgical treatment of endometriosis, which is routinely performed by minimally invasive approach, is developing towards an increasing complexity in deep endometriosis. While RAS appears to be gaining importance, there are few real-life data on its use for patients with endometriosis. The aim of this study is to investigate the current use of RAS in certified endometriosis centers in Central Europe. METHODS: In this international multicentric cross-sectional study, an online branching survey was sent to certified endometriosis centers in Austria, the Czech Republic, Germany, and Switzerland. This survey contained 47 questions including proportion of use, indications, advantages and barriers, technical aspects, and training in RAS. RESULTS: Of the 97 centers contacted, 66% (n = 64) participated. RAS is used for the treatment of endometriosis in 60.8% (n = 31) of the centers with access to a SR, which corresponds to 48.4% of all participating centers. In Austria, 81.8% (n = 9) of centers have SR access, respectively, 88.9% (n = 8) use RAS for endometriosis; in Switzerland, 91.6% (n = 11) and 36.4% (n = 4); and in Germany, 74.4% (n = 29) and 62.1% (n = 18). The reported advantages of RAS include precision (80%, n = 40), instrument mobility (74%, n = 37), and visualization (72%, n = 36). Compared to CLS, RAS is preferred in multidisciplinary cases (84.6%, n = 22), and overweight patients (61.5%, n = 16) and deep endometriosis (61.5%, n = 16). Specific anatomical indications for RAS vs. CLS include FU (57.7%, n = 15), C (53.9%, n = 14), and FB (50%, n = 13) (#Enzian classification). Patient outcomes of RAS compared to CLS are rated as advantageous in 69.2% (n = 18). The main barriers for RAS for centers without an SR include costs (100%, n = 12) and lack of scientific evidence (33.3%, n = 4). 69.2% (n = 18) have dedicated robotic teams, 42.3% (n = 11) have a second console, 69.2% (n = 18) have a simulator, and 34.6% (n = 9) have training programs. A total of 65.4% (n = 17) believes that RAS will replace CLS in selected cases, and 73.1% (n = 19) would prefer RAS if costs were equal. CONCLUSION: This study demonstrates that RAS is already being used in approximately half of the participating endometriosis centers. While the proportion of RAS procedures compared to CLS is increasing, it still remains comparatively low. Country-specific differences in the use of RAS are evident and are most likely linked to healthcare system structures. Participating centers report both technical and general surgical advantages, as well as specific benefits in cases of deep endometriosis. The main barriers include costs and a lack of scientific evidence. Further research is needed to evaluate the long-term role of RAS in the management of endometriosis.

My notes (saved in your browser only)

Outcome instruments

Enzian

Condition tags

endometriosis

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (53)

Source provenance

europepmc
last seen: 2026-06-19T06:14:56.452680+00:00
openalex
last seen: 2026-06-10T17:14:06.276822+00:00
pmc
last seen: 2026-05-13T20:22:03.195721+00:00
pubmed
last seen: 2026-06-19T06:11:39.122732+00:00
License: CC0 · commercial use OK