Long-Term Outcomes in Robotic Compared With Conventional Laparoscopy for the Treatment of Severe Endometriosis

INTRODUCTION: To determine long-term outcome differences in patients undergoing robotic-assisted compared with conventional laparoscopy for advanced-stage endometriosis. METHODS: Cases were collected from our prospectively maintained computerized database of robotic-assisted and conventional laparoscopic surgical treatments for endometriosis. Included were all patients treated between July 2009 and October 2012 for endometriosis stage III or IV (American Society for Reproductive Medicine). A questionnaire composed of questions ranging from assessing postoperative pain to subsequent medical or surgical treatment followed by future pregnancies was distributed to all patients and compared between the groups. In addition, patients were divided into subgroups of those who had hysterectomy and those who did not. A χ2 test was used to compare presence of long-term outcomes between conventional laparoscopic surgical and robotic-assisted laparoscopic surgery groups. The level of significance was set as 5%. RESULTS: Included were 54 conventional laparoscopic surgical and 23 robotic-assisted laparoscopic surgery participants. Patients undergoing conventional laparoscopic surgery who did not undergo hysterectomy needed additional medical treatment for endometriosis after the surgery mainly for unresolved pain compared with patients undergoing conventional laparoscopic surgery (P=.01 and P<.5, respectively). No significant differences were noted between robotic-assisted laparoscopic surgery and conventional laparoscopic surgical groups when comparing postoperative pain, subsequent medical or surgical treatment, and future pregnancies. CONCLUSIONS: In contrast to the robotic-assisted laparoscopic surgery group, patients undergoing conventional laparoscopic surgery who did not have hysterectomy needed additional medical treatment for endometriosis after the surgery, mainly for unresolved pain compared with patients undergoing conventional laparoscopic surgical hysterectomy. Despite the known advantages of the robot, no statistical differences in long-term outcomes were found between conventional laparoscopic surgical and robotic-assisted laparoscopic surgical groups for treatment of advanced-stage endometriosis.