Comparison of surgical outcomes between robot-assisted and conventional laparoscopic hysterectomy for stage IV endometriosis: A propensity score-matched analysis and review of the literature

Minimally invasive surgery, especially laparoscopic surgery, remains the standard treatment for endometriosis; however, robotic-assisted surgery (RAS) is also gaining adoption. Several meta-analyses have reported comparable perioperative outcomes between RAS and conventional laparoscopy. This retrospective cohort study aimed to compare the surgical outcomes between RAS and conventional laparoscopic surgery (CLS) for hysterectomy in patients with severe endometriosis. Among 2,466 minimally invasive hysterectomies performed for benign gynecologic diseases between October 2021 and December 2024, 223 patients with severe endometriosis (revised American Society for Reproductive Medicine [rASRM] stage IV) were identified. After excluding cases requiring concomitant gastrointestinal or urologic procedures, 154 patients were included (RAS, n = 86; CLS, n = 68). Propensity score matching (1:1) was performed using covariates including rASRM score, ENZIAN classification, body mass index, prior abdominal surgery, and uterine weight. After matching, 96 patients were analyzed (48 per group). Operative time, estimated blood loss, and postoperative hemoglobin change were 97 vs. 110 min (p = 0.179), 50 vs. 100 mL (p = 0.002), and ˗1.2 vs. ˗1.1 g/dL (p = 0.605) in the RAS and CLS groups, respectively. Intraoperative complication rates were 0% vs. 2.1% (p = 1.000), and postoperative complication rates were identical at 8.3% in both groups (p = 1.000). RAS hysterectomy in patients with severe endometriosis was associated with significantly lower blood loss and comparable operative time compared with CLS, with no differences in perioperative complications. These findings suggest a potential advantage of RAS; however, further studies are warranted. Similar content being viewed by others Data availability The datasets generated and/or analyzed during the current study are not publicly available due to institutional and ethical restrictions but are available from the corresponding author on reasonable request.

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We would like to thank Editage (www.editage.jp) for their support in English-language editing. Author information Authors and Affiliations Contributions Kiyoshi Kanno was responsible for the conception and design of this study. Material preparation and data collection were performed by all authors. Data analysis was performed by Naofumi Higuchi. The first draft of the manuscript was written by Naofumi Higuchi and Kiyoshi Kanno, and all authors commented on previous versions of the manuscript. All authors read and approved of the final manuscript. Corresponding author Ethics declarations Competing interests The authors declare no competing interests. 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. Supplementary Material 1 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 Higuchi, N., Kanno, K., Sasamori, C. et al. Comparison of surgical outcomes between robot-assisted and conventional laparoscopic hysterectomy for stage IV endometriosis: A propensity score-matched analysis and review of the literature. J Robotic Surg 20, 323 (2026). https://doi.org/10.1007/s11701-026-03299-4 Received: Accepted: Published: Version of record: DOI: https://doi.org/10.1007/s11701-026-03299-4