Visualization of endometriosis: comparative study of 3-dimensional robotic and 2-dimensional laparoscopic endoscopes

C.M. Mosbrucker, Anita Somani, Somani A, Dulemba J, John Dulemba
Journal of robotic surgery · 2017 · vol. 12(1) , pp. 59–66 · doi:10.1007/s11701-017-0686-0 · PMID:28255736 · W2593170846
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-27 ⓘ

The robotic 3D/HD scope detected significantly more histologically confirmed endometriosis lesions than the 2D/HD laparoscope across all locations and sizes.

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This study compared visual detection of histologically confirmed endometriosis using a robotic 3D/HD scope versus a 2D/HD laparoscope in premenopausal women (≥18 years) randomized to receive 2D/HD visualization either before or after 3D/HD visualization, with resections then performed robotically by three surgeons. Across 98 patients, 598 lesions were visualized, and 58.4% of resected lesions were confirmed as endometriosis on histopathology. All confirmed lesions (100%) were detected with the robotic 3D/HD scope versus 77.9% with the 2D/HD laparoscope, with higher detection across multiple anatomic locations and lesion appearance/size categories (p<0.001), and logistic regression showing independent association of 3D/HD use with greater likelihood of detecting a confirmed lesion (OR 2.36, p=0.014). A major limitation explicitly stated is the need for larger, long-term multi-practice studies to determine effects on symptomatology, recurrence, and fertility outcomes. This paper is centrally about endometriosis—comparing robotic 3D versus laparoscopic 2D visualization for detecting histologically confirmed endometriosis lesions.

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Abstract

The main objective of this study was to compare results of using the robotic 3D/HD scope and the 2D/HD laparoscope for visual detection of histologically confirmed endometriosis. Three surgeons from different practices enrolled premenopausal women ≥18 years who had elected to undergo robotic-assisted endometriosis resection. Patients were randomized to receive 2D/HD laparoscopic visualization either before or after 3D/HD robotic visualization. Resections then proceeded robotically. The number of histologically confirmed lesions overall and by abdomino-pelvic location, appearance and size was compared by scope type used. During the study, 598 lesions were visualized in 98 patients. Average number of lesions per patient using either scope was 6.1. Mean age was 31 years and 77% were disease stage I/II. On histopathology, 58.4% of lesions resected were consistent with endometriosis. All (100%) of these lesions were detected using the robotic 3D/HD scope and 77.9% using the 2D/HD laparoscope (p < 0.001). Compared to laparoscopic, robotic visualization resulted in detection of more confirmed lesions in all anatomic locations and for most appearances, including the cul-de-sac (100 vs. 79%), atypical appearance (100 vs. 71.3%) and width <5 mm (100 vs. 62%), p's < 0.001). Logistic regression indicated that use of the 3D/HD robotic scope was independently associated with 2.36 times the likelihood (95% CI 1.20, 4.66; p = 0.014) of detecting a confirmed lesion, compared to the 2D/HD laparoscope. Large-scale, long-term studies are needed to substantiate these findings in multiple practice settings and to determine whether 3D robotic versus 2D laparoscopic resection has a beneficial impact on symptomatology, recurrence and fertility outcomes.
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Abstract

The main objective of this study was to compare results of using the robotic 3D/HD scope and the 2D/HD laparoscope for visual detection of histologically confirmed endometriosis. Three surgeons from different practices enrolled premenopausal women ≥18 years who had elected to undergo robotic-assisted endometriosis resection. Patients were randomized to receive 2D/HD laparoscopic visualization either before or after 3D/HD robotic visualization. Resections then proceeded robotically. The number of histologically confirmed lesions overall and by abdomino-pelvic location, appearance and size was compared by scope type used. During the study, 598 lesions were visualized in 98 patients. Average number of lesions per patient using either scope was 6.1. Mean age was 31 years and 77% were disease stage I/II. On histopathology, 58.4% of lesions resected were consistent with endometriosis. All (100%) of these lesions were detected using the robotic 3D/HD scope and 77.9% using the 2D/HD laparoscope (p < 0.001). Compared to laparoscopic, robotic visualization resulted in detection of more confirmed lesions in all anatomic locations and for most appearances, including the cul-de-sac (100 vs. 79%), atypical appearance (100 vs. 71.3%) and width <5 mm (100 vs. 62%), p’s < 0.001). Logistic regression indicated that use of the 3D/HD robotic scope was independently associated with 2.36 times the likelihood (95% CI 1.20, 4.66; p = 0.014) of detecting a confirmed lesion, compared to the 2D/HD laparoscope. Large-scale, long-term studies are needed to substantiate these findings in multiple practice settings and to determine whether 3D robotic versus 2D laparoscopic resection has a beneficial impact on symptomatology, recurrence and fertility outcomes. Similar content being viewed by others

References

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Acknowledgements

The authors wish to acknowledge Shilpa Mehendale, MS, MBA and Ali Andreasen, MD, of Intuitive Surgical, Bharathi Lingala, PhD, Stanford University and Helen Hubert, PhD, Consulting Epidemiologist for their support during study execution, analysis and manuscript preparation. Author information Authors and Affiliations Corresponding author Ethics declarations Conflict of interest Cindy Mosbrucker, MD is a Proctor at Intuitive Surgical, Inc. Anita Somani, MD and John Dulemba, MD were formerly Proctors at Intuitive Surgical, Inc. Funding This study was sponsored and funded by Intuitive Surgical Inc., Sunnyvale, CA, USA in association with the study investigators (co-authors) under a cooperative clinical trial agreement. The authors had full control of the study execution, analysis and development of the manuscript. Research involving human participants All procedures performed in these studies were approved by the Institutional Review Board at each site and were in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent Informed consent was obtained from all individual participants included in the study. Rights and permissions About this article Cite this article Mosbrucker, C., Somani, A. & Dulemba, J. Visualization of endometriosis: comparative study of 3-dimensional robotic and 2-dimensional laparoscopic endoscopes. J Robotic Surg 12, 59–66 (2018). https://doi.org/10.1007/s11701-017-0686-0 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s11701-017-0686-0

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Condition tags

endometriosischronic_pelvic_pain

MeSH descriptors

Endometriosis Laparoscopy Pelvic Pain Robotic Surgical Procedures Adult Endometriosis Equipment Design Female Humans Imaging, Three-Dimensional Laparoscopes Laparoscopy Laparoscopy Pelvic Pain Premenopause Robotic Surgical Procedures Robotic Surgical Procedures

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