Robotic versus laparoscopic colectomy for deep infiltrative endometriosis of the bowel: a propensity-matched analysis of US-based hospitals

Deep infiltrative endometriosis involving the bowel is a complex disease in which the optimal minimally invasive surgical approach remains uncertain, particularly regarding long-term fertility, recurrence, and healthcare utilization. We conducted a retrospective propensity score–matched cohort study using the TriNetX US Collaborative Network, including 72 healthcare organizations. Adult women who underwent minimally invasive colectomy for colorectal endometriosis between October 2013 and October 2025 were identified. Patients with prior hysterectomy, malignancy, inflammatory bowel disease, adenomyosis, or conversion to open surgery were excluded. Robotic colectomy was compared with conventional laparoscopic colectomy. After 1:1 propensity score matching, 487 patients were included in each cohort, with balanced baseline characteristics. At 3 years, robotic colectomy was associated with higher pregnancy achievement compared with laparoscopy (7.2% vs 2.9%; RR 2.50, 95% CI 1.36–4.59), lower endometriosis recurrence (4.3% vs 20.1%; RR 0.21, 95% CI 0.14–0.34), and reduced long-term opioid utilization (68.4% vs 89.3%; RR 0.77, 95% CI 0.72–0.82). At 5 years, these benefits persisted, with higher pregnancy achievement (7.8% vs 3.3%), lower recurrence (4.7% vs 18.5%), reduced opioid utilization (68.0% vs 90.3%), and fewer emergency readmissions (26.7% vs 35.1%). No significant differences were observed in urinary dysfunction, urinary incontinence, pelvic or perineal pain, dysmenorrhea, or dyspareunia. In this propensity-matched analysis, robotic colectomy was associated with higher recorded pregnancy and lower recurrence, opioid use, and readmission; given shorter follow-up and no fertility-intent data, these associations are hypothesis-generating. Similar content being viewed by others Data availability The data that support the findings of this study are available from TriNetX; however, restrictions apply to the availability of these data, which were used under license for the current study and are not publicly available. Data access may be requested through the TriNetX platform, subject to appropriate institutional agreements, data use permissions, and regulatory approval.

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Not applicable. Funding No funding was received for conducting this study or for the preparation of this manuscript. Author information Authors and Affiliations Contributions ME contributed to conceptualization, methodology, analysis, investigation, data curation, visualization, writing of the original draft, and critical revision of the manuscript. DZA contributed to the investigation, visualization, and critical revision of the manuscript. JPL contributed to analysis, investigation, visualization, the original draft, and the critical revision of the manuscript. EMH contributed to conceptualization, supervision, methodology, resources, validation, writing of the original draft, and critical revision of the manuscript. All authors contributed to data interpretation, critically reviewed and revised the manuscript, and approved the final version for submission. All the authors critically reviewed, revised, and approved the final version of the manuscript. Corresponding author Ethics declarations Competing interests Muhammed Elhadi declares no competing interests. Diego Z. Arellano declares no competing interests. Jean-Paul LeFave is a consultant for Intuitive Surgical. Eric M. Haas is a consultant for Axonics and has received a grant from THD America outside the submitted work. Ethics approval This study was conducted in accordance with the principles of the Declaration of Helsinki and applicable regulatory requirements. The study used de-identified data obtained from the TriNetX Research Network. The data reviewed represented a secondary analysis of existing de-identified data and did not involve direct intervention or interaction with human participants. The data were de-identified in accordance with the de-identification standard defined in Section §164.514(a) of the HIPAA Privacy Rule, and the de-identification process was attested to through a formal determination by a qualified expert as defined in Section §164.514(b)(1) of the HIPAA Privacy Rule. Therefore, informed consent was waived. The TriNetX platform is compliant with HIPAA and GDPR regulations, ensuring patient privacy and data security. Consent for publication Not applicable. This study used de-identified data and did not include any individual-level identifiable patient information. 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 Elhadi, M., Arellano, D.Z., LeFave, JP. et al. Robotic versus laparoscopic colectomy for deep infiltrative endometriosis of the bowel: a propensity-matched analysis of US-based hospitals. J Robotic Surg 20, 724 (2026). https://doi.org/10.1007/s11701-026-03690-1 Received: Accepted: Published: Version of record: DOI: https://doi.org/10.1007/s11701-026-03690-1