Does age influence surgical technique in bowel endometriosis? A multicenter analysis of 1547 cases

Objective To evaluate whether patient age influences the complexity of the surgical approach for bowel endometriosis, including the technique performed and the route of specimen extraction. Methods: Retrospective, multicenter observational study, set in tertiary referral hospitals in the state of São Paulo, Brazil. A total of 1,547 patients who underwent surgery for bowel endometriosis between 2016 and 2025. Interventions: Surgical management of bowel endometriosis using one of three techniques: shaving, discoid nodulectomy, or segmental resection. Specimen extraction was performed via Pfannenstiel incision or natural orifice specimen extraction (NOSE). Results: Clinical variables, surgical technique, specimen extraction route, complications (classified by Clavien-Dindo), and associated procedures were analyzed. The mean age was 37.8 years. Conservative techniques were more frequent, with shaving performed in 62.4% of cases. No statistically significant association was found between age and surgical technique (p > 0.05). Severe complications (grade ≥ III) occurred in 1.9% of cases, with no significant difference between age groups. The abdominal extraction route (Pfannenstiel incision) was more commonly used in patients under 35 years (OR 1.42; p = 0.01). Conclusion: Age did not influence the choice of surgical technique or the severity of complications but was associated with the route of specimen extraction, likely due to a higher rate of uterine preservation in younger patients. Similar content being viewed by others Data availability No datasets were generated or analysed during the current study.

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Author information Authors and Affiliations Contributions R Barretto: Data collection and patient recruitment RC Mariano da Silva: Data collection and chart review RP Gonçalves Filho: Data collection and critical review of the manuscript MM Sonnenfeld: Writing of the manuscript, statistical analysis, and figure/table preparation GJ Saba: Data collection and clinical supervision CRR Talaga: Data collection and literature review M Wajman: Data collection and database organization T Moscovitz: Study design, methodological supervision, and text revision CA Ortiz: Data collection and manuscript editing FB Manchini: Data collection and image review AG Manchini: Data collection and discussion input N Rostey: Data collection and clinical case analysis B Mirandola Bulisani: Data collection and formatting support LGL Gomes: Data collection and text formatting MR Rodrigues: Data collection M Ströher: Data collection and patient follow-up M Tcherniakovsky: Scientific supervision, study design, and critical manuscript review LCB do Carmo: Data collection and support in institutional logistics. Corresponding author Ethics declarations Conflict of interest The authors declare no competing interests. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary Information Below is the link to the electronic supplementary material. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Barretto, R., da Silva, R.C.M., Filho, R.P.G. et al. Does age influence surgical technique in bowel endometriosis? A multicenter analysis of 1547 cases. J Robotic Surg 19, 665 (2025). https://doi.org/10.1007/s11701-025-02861-w Received: Accepted: Published: Version of record: DOI: https://doi.org/10.1007/s11701-025-02861-w