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, Satish Warrier, Christina Fleming, Helen Mohan
International journal of colorectal disease · 2024 · vol. 39(1) , pp. 98 · doi:10.1007/s00384-024-04669-w · PMID:38922440 · PMC11208225 · W4400048617
review OA: gold CC0 ⤵ 7 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

Robot-assisted laparoscopy for deep infiltrating endometriosis with bowel involvement showed longer operative times but shorter hospital stays and fewer complications compared to standard laparoscopy, indicating IDEAL Stage 2B development.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-08 ⓘ

This systematic review evaluated feasibility and outcomes of robot-assisted laparoscopic surgery (RALS) versus standard laparoscopic surgery (SLS) for symptomatic bowel deep infiltrating endometriosis, identifying 11 primary studies (364 RALS and 83 SLS patients) published up to August 2023. Across included studies, RALS had longer mean operating times (235 ± 112 min vs 171 ± 76 min, p < 0.01) but shorter hospital stays (5.3 ± 3.5 vs 7.3 ± 4.1 days, p < 0.01) and fewer postoperative complications overall, though the evidence base remained limited to nonrandomized designs in most studies. The authors note that patient allocation in comparative cohorts depended on robotic theatre availability rather than formal randomization, and the overall evidence for RALS in bowel deep infiltrating endometriosis was at IDEAL Stage 2B. This paper is centrally about endometriosis — specifically the role of robot-assisted laparoscopy for bowel deep infiltrating endometriosis with bowel involvement.

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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. 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 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: Eleven 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). Patients in the RALS group experienced a shorter hospital stay (5.3 ± 3.5 days vs. 7.3 ± 4.1 days) (p < 0.01), and appeared to have fewer postoperative complications compared to standard laparoscopy. Research evidence for RALS in bowel DE is at an IDEAL Stage 2B of development. CONCLUSION: RALS is a safe and feasible alternative to standard laparoscopy for bowel endometriosis treatment, with a shorter overall length of stay despite longer operating times. Further robust randomized trials recommended to delineate other potential advantages of RALS.

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Condition tags

endometriosisdie_deep_infiltratingbowel_endometriosis

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Laparoscopy Laparoscopy Laparoscopy Laparoscopy Laparoscopy Laparoscopy Laparoscopy Robotic Surgical Procedures Robotic Surgical Procedures Robotic Surgical Procedures Robotic Surgical Procedures

Citation neighborhood

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 (49)

Cited by (7)

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