The role of robotic surgery in the treatment of advanced endometriosis: a systematic review and meta-analysis

INTRODUCTION: Advanced endometriosis (Stage III/IV) represents a particularly severe variant of endometriosis with more pronounced symptomatology and challenging surgical treatment. This review shall examine the role of robotic surgery, the latest breakthrough in surgical technology, in addressing this challenging condition. EVIDENCE ACQUISITION: A systematic search of the literature in peer-reviewed databases was performed, focusing mainly on surgical outcomes. Meta-analysis was performed on comparative studies. Studies included in the meta-analysis were also subjected to risk of bias assessment and sensitivity analysis. EVIDENCE SYNTHESIS: From the initial study pool, ultimately 36 studies were included, which indicated that robotic surgery was safe and feasible, with satisfactory surgical outcomes. Long-term quality of life and fertility outcomes were also positive, particularly for endometriosis-related pain, gastrointestinal symptoms and infertility, with 25-100% pregnancy rate after surgery. Comparative data versus laparoscopy, indicated no statistically significant differences between the two approaches with regard to blood loss, hospitalization or complications (including transfusion, conversion to open surgery, re-hospitalization and re-operation), although operative time was significantly longer for robotic surgery (WMD: 38.32, 95%CI: 24.14, 52.49, P<0.001). However, Robotic surgery was superior in addressing endometriosis-related pain and was less harmful on ovarian reserve according to two studies. CONCLUSIONS: Robotic surgery for advanced endometriosis is a safe and viable approach. While current data reveal no differences in surgical outcomes compared to laparoscopy, the lack of randomized studies precludes definitive conclusions. Future research should focus on patient randomization and on identifying subgroups that would most benefit from the application of this novel technology.