Evaluating the Impact of Robotic-Assisted Laparoscopic Surgery on Health-Related Quality of Life (HRQoL) in Endometriosis Patients Using the Endometriosis Health Profile (EHP-30)

Introduction: Endometriosis is a chronic gynecological condition that significantly impacts the health-related quality of life (HRQoL) of affected individuals. Characterized by the presence of endometrial-like tissue outside the uterus, endometriosis often results in debilitating pain, infertility, and a reduced quality of life. Surgical intervention, particularly robotic-assisted laparoscopic excision, has emerged as a pivotal treatment modality aimed at alleviating symptoms and improving HRQoL. However, the extent of its impact on various dimensions of patients’ lives remains to be thoroughly evaluated. This study employs the Endometriosis Health Profile (EHP-30), a validated instrument specifically designed to assess the multifaceted effects of endometriosis on HRQoL. By examining EHP-30 scores pre-operatively, at 2 weeks, and at 12-20 weeks or more post-operatively, this research aims to clarify the short- and long-term benefits of surgical intervention. Additionally, the study investigates differences in outcomes between patients with superficial endometriosis (SE) and those with deep infiltrating endometriosis (DIE), providing a comprehensive understanding of how these subtypes respond to surgical treatment. Materials and Methods: This prospective observational study assesses the impact of robotic-assisted laparoscopic surgery on HRQoL in women with histopathologically-confirmed endometriosis. Conducted from April 27, 2023, to the present, the study involved four major hospitals known for their expertise in managing endometriosis. Women aged 18 and older with suspected pelvic endometriosis were included, contingent on histopathological confirmation post-surgery. Exclusion criteria eliminated those without confirmed endometriosis or severe systemic diseases. The study cohort consisted of 55 women with a mean age of 33.9 years and a mean BMI of 30.38. Participants were predominantly White (67.3%), with Hispanic (18.2%) and Asian (12.7%) representation. Most were employed (80.0%), non-smokers (96.4%), and nulliparous (83.6%), with 63.6% reporting light-moderate alcohol use and 29.1% using marijuana. Chronic pelvic pain was the most common symptom (70.9%), followed by dysmenorrhea (69.1%) and dyspareunia (41.8%). The primary outcome was the change in EHP-30 scores, which assess five domains: pain, control and powerlessness, emotional well-being, social support, and self-image. Scores were collected pre-operatively, at 2 weeks post-op, and between 12 to 20 weeks post-op. To minimize variability, a single minimally invasive gynecologic surgeon performed all surgeries, following a standardized protocol to ensure consistency in surgical technique and outcomes. Patients were classified into SE and DIE groups based on surgical findings and histopathological reports. Power analysis using G*Power 3.1.9.6 determined a sample size of 54 for matched pairs with 95% power. Results: A total of 90 patients were recruited, with 55 completing the study. Exclusions included 12 patients without endometriosis on pathology, 1 with an ovarian tumor, 3 with endosalpingiosis only, 4 due to surgery cancellations, and 3 who withdrew. The analysis included 28 SE and 27 DIE patients. The EHP-30 scores showed statistically significant reductions in total and individual scores at 2 weeks and 12-20 weeks post-operation (P < 0.05 for social support dimension at 2 weeks in the DIE subgroup, all other P < 0.001). A significant difference in pain was noted between DIE and SE subgroups at 12-20 weeks post-surgery (P < 0.05), with DIE patients experiencing higher pain levels. No significant differences were observed between subgroups in other categories or total scores at any time point. Conclusion: The findings underscore the significant role of robotic-assisted laparoscopic excision in enhancing HRQoL for endometriosis patients. The marked improvement in EHP-30 scores post-operatively highlights the effectiveness of surgical intervention in alleviating symptoms and improving overall well-being. Data reveal that patients with DIE experience substantial relief, which is particularly significant given the often-severe symptomatology associated with this subtype. This suggests that surgical excision can effectively address the more invasive manifestations of endometriosis, offering hope for those who previously faced limited options. Robotic-assisted laparoscopic excision significantly improves HRQoL in endometriosis patients, as measured by EHP-30, regardless of whether they have DIE or SE. Sustained improvement observed in both the short- and long-term post-operative periods indicates that the benefits of surgery are not only immediate but also persistent. This long-lasting impact is crucial, as it suggests that surgical intervention can provide a stable solution for symptom management, reducing the need for ongoing medical therapy and its associated side effects. These findings advocate for considering surgical intervention as a primary treatment option in appropriate cases, particularly for those patients who have not achieved adequate relief through medical management alone. However, pain may recur long-term, particularly in DIE patients. Continued recruitment of SE and DIE patients is necessary to further this ongoing study.