Role of robot-assisted laparoscopy in deep-infiltrating endometriosis with bowel involvement: a systematic review and application of the IDEAL framework

Hwa Ian Ong, Nastassia Shulman, Patrick Nugraha, Stephen Wrenn, Deirdre Nally, Colin Peirce, Uzma Mahmood, Jacob McCormick, David Proud, Satish K. Warrier, Christina Fleming, Helen Mohan
In: Research Square · 2024 · doi:10.21203/rs.3.rs-4084202/v1 · W4392905732
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

Robot-assisted laparoscopy for deep infiltrating endometriosis with bowel involvement shows longer operative times but fewer postoperative complications and shorter hospital stays compared to standard laparoscopy.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This systematic review evaluated robot-assisted laparoscopic surgery (RALS) as an alternative to standard laparoscopic surgery (SLS) for symptomatic bowel deep-infiltrating endometriosis (BDIE), synthesizing 11 primary studies published up to August 2023 across Medline, Embase, PubMed, and Cochrane sources. Across 364 RALS and 83 SLS patients, extracted operative details and outcomes showed longer mean operating times with RALS (235 ± 112 min vs. 171 ± 76 min; p < 0.01) but fewer postoperative complications (15.3% vs. 26.5%) and shorter hospital stays (5.3 ± 3.5 vs. 7.3 ± 4.1 days; p < 0.01). The authors staged the evidence for RALS in BDIE at IDEAL Stage 2B, and the main caveat is that the included evidence consisted largely of case series and limited comparative data, with staging and risk-of-bias assessments necessarily applied using non-IDEAL-formatted studies. This paper is centrally about endometriosis — it systematically reviews RALS for bowel deep-infiltrating endometriosis with bowel involvement and applies the IDEAL framework to the evidence base.

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Abstract

Abstract Aims This review aims to evaluate the feasibility of robot-assisted laparoscopic surgery (RALS) as an alternative to standard laparoscopic surgery (SLS) for the treatment of bowel deep-infiltrative endometriosis (1). Additionally, it aims to provide guidance for future study design, by gaining insight into the current state of research, in accordance with the IDEAL framework. Method A systematic review was conducted to identify relevant studies on RALS for bowel deep infiltrating endometriosis (BDIE) in Medline, Embase, Cochrane Library, and PubMed databases up to August 2023 and reported in keeping with PRISMA guidelines, The study was registered with PROSPERO Registration: CRD42022308611 Results 11 primary studies were identified, encompassing 364 RALS patients and 83 SLS patients, from which surgical details, operative and postoperative outcomes were extracted. In the RALS group, mean operating time was longer (235 ± 112 min) than in the standard laparoscopy group (171 ± 76 min) (p < 0.01). However, RALS resulted in fewer postoperative complications (15.3%) compared to standard laparoscopy (26.5%). Patients in the RALS group experienced a shorter hospital stay (5.3 ± 3.5 days vs. 7.3 ± 4.1 days) (p < 0.01). Research evidence for RALS in BDIE is at an IDEAL Stage 2B of development. Conclusion RALS is a safe and feasible alternative to standard laparoscopy for bowel endometriosis treatment, potentially improving rates of intraoperative and overall postoperative complications despite longer operating times.

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Outcome instruments

VAS-pain

Condition tags

endometriosisdie_deep_infiltratingbowel_endometriosis

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (50)

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