Comparative effectiveness of robot-assisted and laparoscopic procedures in deep infiltrating endometriosis

A. O. Hryhorenko
In: Medical Science of Ukraine (MSU) · 2026 · vol. 22(2) , pp. 24–30 · doi:10.32345/2664-4738.2.2026.03 · W7171313453
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Robot-assisted surgery expands possibilities for complex deep infiltrating endometriosis, while laparoscopy remains the primary method with similar perioperative outcomes.

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This review analyzes current scientific literature comparing the clinical outcomes and safety of robot-assisted versus conventional laparoscopic surgery for deep infiltrating endometriosis. The authors found that while laparoscopy remains the primary surgical method, robotic assistance offers superior visualization and precision for complex cases involving adjacent pelvic organs or bowel infiltration. Perioperative metrics such as blood loss, complication rates, and hospitalization length were generally similar between the two approaches, though the paper notes a need for more evidence regarding long-term outcomes. This paper is centrally about endometriosis — specifically evaluating surgical techniques for deep infiltrating lesions, with adenomyosis mentioned only in the context of one cited study protocol.

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Abstract

Relevance. The importance of the study is determined by the high prevalence of endometriosis among women of reproductive age and by the substantial negative effect of deep infiltrating endometriosis on the functional state of the pelvic organs, the quality of life of patients, and treatment outcomes. Despite the active development of minimally invasive gynaecological surgery, the choice of the optimal surgical approach for complex infiltrative forms of the disease remains debatable. An analysis of current scientific data on the effectiveness of robot-assisted and laparoscopic procedures is therefore especially relevant. Aim. To summarise current scientific data on the use of robot-assisted and laparoscopic surgical procedures in deep infiltrating endometriosis and to analyse their clinical outcomes and features of use in minimally invasive gynaecological surgery. Materials and methods. The study used methods of analysis, systematisation, and generalisation of current scientific sources devoted to the problem of surgical treatment of deep infiltrating endometriosis. The results of clinical studies, systematic reviews, and meta-analyses concerning the effectiveness and safety of robot-assisted and laparoscopic procedures were analysed. Approaches to analytical generalisation of perioperative indicators and clinical treatment outcomes were applied. Results. Current approaches to the surgical treatment of deep infiltrating endometriosis were examined, and the role of laparoscopic and robot-assisted technologies in minimally invasive gynaecological surgery was determined. A generalisation of scientific data indicated that laparoscopic procedures remain the main method of surgical treatment for this pathology, whereas robot-assisted technologies broaden the possibilities for performing complex operations in cases of deep tissue infiltration and involvement of adjacent pelvic organs. It was established that, according to perioperative indicators such as intraoperative blood loss, complication rate, and length of hospitalisation, the results of both approaches were similar in most studies. Robotic systems may provide improved visualisation of the surgical field and greater precision of manipulation during treatment of complex anatomical localisations of the pathological process. Conclusions. The analysis of the contemporary scientific sources indicated that the effectiveness of treatment for deep infiltrating endometriosis depends largely on the correct choice of surgical tactics and on individualisation of the surgical approach. Laparoscopic surgery remains the basic method of surgical treatment, whereas robot-assisted technologies should be used in complex clinical cases requiring high precision of surgical manipulation. The results obtained confirm the need for further accumulation of evidence on the long-term outcomes of different minimally invasive surgical technologies in deep infiltrating endometriosis.
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Abstract

Relevance. The importance of the study is determined by the high prevalence of endometriosis among women of reproductive age and by the substantial negative effect of deep infiltrating endometriosis on the functional state of the pelvic organs, the quality of life of patients, and treatment outcomes. Despite the active development of minimally invasive gynaecological surgery, the choice of the optimal surgical approach for complex infiltrative forms of the disease remains debatable. An analysis of current scientific data on the effectiveness of robot-assisted and laparoscopic procedures is therefore especially relevant. Aim. To summarise current scientific data on the use of robot-assisted and laparoscopic surgical procedures in deep infiltrating endometriosis and to analyse their clinical outcomes and features of use in minimally invasive gynaecological surgery.

Materials

and methods. The study used methods of analysis, systematisation, and generalisation of current scientific sources devoted to the problem of surgical treatment of deep infiltrating endometriosis. The results of clinical studies, systematic reviews, and meta-analyses concerning the effectiveness and safety of robot-assisted and laparoscopic procedures were analysed. Approaches to analytical generalisation of perioperative indicators and clinical treatment outcomes were applied. Results. Current approaches to the surgical treatment of deep infiltrating endometriosis were examined, and the role of laparoscopic and robot-assisted technologies in minimally invasive gynaecological surgery was determined. A generalisation of scientific data indicated that laparoscopic procedures remain the main method of surgical treatment for this pathology, whereas robot-assisted technologies broaden the possibilities for performing complex operations in cases of deep tissue infiltration and involvement of adjacent pelvic organs. It was established that, according to perioperative indicators such as intraoperative blood loss, complication rate, and length of hospitalisation, the results of both approaches were similar in most studies. Robotic systems may provide improved visualisation of the surgical field and greater precision of manipulation during treatment of complex anatomical localisations of the pathological process. Conclusions. The analysis of the contemporary scientific sources indicated that the effectiveness of treatment for deep infiltrating endometriosis depends largely on the correct choice of surgical tactics and on individualisation of the surgical approach. Laparoscopic surgery remains the basic method of surgical treatment, whereas robot-assisted technologies should be used in complex clinical cases requiring high precision of surgical manipulation. The results obtained confirm the need for further accumulation of evidence on the long-term outcomes of different minimally invasive surgical technologies in deep infiltrating endometriosis.

References

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Robotic versus laparoscopic surgery for severe deep endometriosis: Protocol for a randomised controlled trial (ROBEndo trial). BMJ Open. 2022;12(7):e063572. DOI: 10.1136/bmjopen-2022-063572 This work is licensed under a Creative Commons Attribution 4.0 International License.

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