Comparison of perioperative outcomes between robotic surgery and traditional laparoscopy for colorectal endometriosis: a systematic review and meta-analysis

Robotic-assisted surgery (RAS) offers a broader surgical field, enhanced visualization, and greater instrument maneuverability, suggesting potential advantages over traditional laparoscopic surgery (LPS), which is currently the gold standard for treating colorectal endometriosis. To address this gap, we conducted a comprehensive review of existing studies to compare the perioperative outcomes of RAS and LPS in the management of colorectal endometriosis. A comprehensive search was conducted in the databases of PubMed, Web of Science, the Cochrane Library, and SpringerLink to identify any studies that prior to February 2nd, 2025. To compare RAS to LPS for colorectal endometriosis, we looked at things like operation duration, expected blood loss, length of stay, conversion to laparotomy, all complications, and bowel endometriosis resection. The operative time for RAS in colorectal endometriosis resection was significantly longer than that for LPS (data aggregated from six studies; WMD 21.51 min, 95% CI 4.58–38.43, p < 0.05). However, there were no significant differences between the two groups in intraoperative blood loss (four studies; WMD 1.2 ml, 95% CI − 34.01–36.41, p = 0.95), length of hospital stay (four studies; WMD 0.2 days, 95% CI − 1.09–1.49, p = 0.76), or the number of cases requiring conversion to laparotomy (four studies; OR 2.27, 95% CI 0.52–9.95, p = 0.28) (Fig. 2). LPS demonstrated a significantly higher utilization of segmental resection (six studies; OR 0.71, 95% CI 0.54–0.93, p < 0.05), while no significant differences were observed in the rates of shaving (six studies; OR 1.06, 95% CI 0.77–1.47, p = 0.71) or double discoid excision (six studies; OR 1.3, 95% CI 0.95–1.78, p = 0.1) (Fig. 3). Additionally, the included studies reported no significant differences in overall complication rates (five studies; OR 0.9, 95% CI 0.64–1.28, p = 0.57) (Fig. 3) or the incidence of Clavien–Dindo classification complications classified as Grade I(five studies; OR 0.85, 95% CI 0.44–1.65, p = 0.64), II(five studies; OR 0.59, 95% CI 0.35–1.0, p = 0.5), III(five studies; OR 1.12, 95% CI 0.63–2.0, p = 0.7), or IV(five studies; OR 0.8, 95% CI 0.14–4.59, p = 0.81). Our study found that, apart from a significantly longer operative time for RAS compared to LPS, RAS demonstrated comparable outcomes in intraoperative blood loss, length of hospital stay, conversion to open surgery, bowel endometriosis resection, and postoperative complication rates. These findings suggest that RAS has the potential to become a viable alternative to LPS in the future. However, this conclusion still requires validation through large-scale, prospective, randomized controlled trials. Similar content being viewed by others Data availability The authors affirm that the data underpinning the findings of this study can be found within the article itself. Further enquiries can be directed to the corresponding author.

Vallvé-Juanico J, Houshdaran S, Giudice LC (2019) The endometrial immune environment of women with endometriosis. Hum Reprod Update 25(5):565–592 Horne AW, Daniels J, Hummelshoj L, Cox E, Cooper KG (2019) Surgical removal of superficial peritoneal endometriosis for managing women with chronic pelvic pain: time for a rethink? BJOG 126(12):1414–1416 Johnson NP, Hummelshoj L, Adamson GD, Keckstein J, Taylor HS, Abrao MS et al (2017) World endometriosis society consensus on the classification of endometriosis. Hum Reprod 32(2):315–324 Darai E, Thomassin I, Barranger E, Detchev R, Cortez A, Houry S et al (2005) Feasibility and clinical outcome of laparoscopic colorectal resection for endometriosis. Am J Obstet Gynecol 192(2):394–400 Fauconnier A, Chapron C, Dubuisson JB, Vieira M, Dousset B, Bréart G (2002) Relation between pain symptoms and the anatomic location of deep infiltrating endometriosis. Fertil Steril 78(4):719–726 Balla A, Quaresima S, Subiela JD, Shalaby M, Petrella G, Sileri P (2018) Outcomes after rectosigmoid resection for endometriosis: a systematic literature review. Int J Colorectal Dis 33(7):835–847 Bendifallah S, Vesale E, Daraï E, Thomassin-Naggara I, Bazot M, Tuech JJ et al (2020) Recurrence after surgery for colorectal endometriosis: a systematic review and meta-analysis. J Minim Invasive Gynecol 27(2):441–451 Bendifallah S, Roman H, Mathieu d’Argent E, Touleimat S, Cohen J, Darai E et al (2017) Colorectal endometriosis-associated infertility: should surgery precede ART? Fertil Steril 108(3):525–531 Gala RB, Margulies R, Steinberg A, Murphy M, Lukban J, Jeppson P, Aschkenazi S, Olivera C, South M, Lowenstein L, Schaffer J, Balk EM, Sung V (2014) Society of gynecologic surgeons systematic review group. systematic review of robotic surgery in gynecology: robotic techniques compared with laparoscopy and laparotomy. J Minim Invasive Gynecol 21(3):353–361 Kim SI, Yoo JG, Lee SJ, Park DC, Yooh JH (2023) Robot-assisted versus conventional laparoscopic radical hysterectomy in cervical cancer stage IB1. Int J Med Sci 20(3):287–291 Moher D, Shamseer L, Clarke M et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4:1 Cumpston M, Li T, Page MJ et al (2019) Updated guidance for trusted systematic reviews: a new edition of the Cochrane handbook for systematic reviews of interventions. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.ED000142 Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213 Stang A (2010) Critical evaluation of the Newcastle–Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25(9):603–605 Lau J, Ioannidis JP, Terrin N et al (2006) The case of the misleading funnel plot. BMJ 333:597–600 Crestani A, Le Gac M, de Labrouhe É, Touboul C, Bendifallah S, Ferrier C, Dabi Y, Darai E (2024) Outcomes of discoid excision and segmental resection for colorectal endometriosis: robotic versus conventional laparoscopy. J Robot Surg 18(1):87 Crestani A, Bibaoune A, Le Gac M, Dabi Y, Kolanska K, Ferrier C, Bendifallah S, Touboul C, Darai E (2023) Changes in hospital consumption of opioid and non-opioid analgesics after colorectal endometriosis surgery. J Robot Surg 17(6):2703–2710 Ferrier C, Le Gac M, Kolanska K, Boudy AS, Dabi Y, Touboul C, Bendifallah S, Daraï E (2022) Comparison of robot-assisted and conventional laparoscopy for colorectal surgery for endometriosis: a prospective cohort study. Int J Med Robot 18(3):e2382 Boudy AS, Jayot A, Bendifallah S, Daraï E (2020) Comparison of robotic versus conventional laparoscopy for the treatment of colorectal endometriosis: pilot study of an expert center. J Gynecol Obstet Hum Reprod 29:101885 Raimondo D, Alboni C, Orsini B, Aru AC, Farulla A, Maletta M, Arena A, Del Forno S, Sampogna V, Mastronardi M, Petrillo M, Seracchioli R (2021) Comparison of perioperative outcomes between standard laparoscopic and robot-assisted approach in patients with rectosigmoid endometriosis. Acta Obstet Gynecol Scand 100(9):1740–1746 Volodarsky-Perel A, Merlot B, Denost Q, Dennis T, Chanavaz-Lacheray I, Roman H (2023) Robotic-assisted versus conventional laparoscopic approach in patients with large rectal endometriotic nodule: the evaluation of safety and complications. Colorectal Dis 25(11):2233–2242 Abo C, Roman H, Bridoux V et al (2017) Chirurgie de l’endométriose profonde par cœlioscopie avec assistance robotique: expérience de 3 ans. J Gynecol Obstet Hum Reprod 46(1):9–18 Chen S-H, Li Z-A, Du X-P (2016) Robot-assisted versus conventional laparoscopic surgery in the treatment of advanced stage endometriosis: a meta-analysis. CEOG 43(3):422–426 Restaino S, Mereu L, Finelli A, Spina MR, Marini G, Catena U et al (2020) Robotic surgery vs laparoscopic surgery in patients with diagnosis of endometriosis: a systematic review and metaanalysis. J Robot Surg 14(5):687–694 Soto E, Luu TH, Liu X, Magrina JF, Wasson MN, Einarsson JI et al (2017) Laparoscopy vs. robotic surgery for endometriosis (LAROSE): a multicenter, randomized, controlled trial. Fertil Steril 107(4):996–1002 Bokhari MB, Patel CB, Ramos-Valadez DI, Ragupathi M, Haas EM (2011) Learning curve for robotic-assisted laparoscopic colorectal surgery. Surg Endosc 25:855–860 McBride K, Stefens D, Stanislaus C, Solomon M, Anderson T, Thanigasalam R et al (2021) Detailed cost of robotic-assisted surgery in the Australian public health sector: from implementation to a multi-specialty caseload. BMC Health Serv Res 21(1):108 Ong HI, Shulman N, Nugraha P, Wrenn S, Nally D, Peirce C, Mahmood U, McCormick J, Proud D, Warrier S, Fleming C, Mohan H (2024) Role of robot-assisted laparoscopy in deep infiltrating endometriosis with bowel involvement: a systematic review and application of the IDEAL framework. Int J Colorectal Dis 39(1):98 Becker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L et al (2022) ESHRE guideline: endometriosis. Hum Reprod Open 2022(2):hoac009 Donnez O, Roman H (2017) Choosing the right surgical technique for deep endometriosis: shaving, disc excision, or bowel resection? Fertil Steril 108(6):931–942 Hur C, Falcone T (2021) Robotic treatment of bowel endometriosis. Best Pract Res Clin Obstet Gynaecol 71:129–143 Funding The authors have received no financial support for the research, authorship, or publication of this manuscript. Author information Authors and Affiliations Contributions XZ and XZ played a pivotal role in the formulation of this study. Every author played a role in the implementation of the project. XZ and XZ undertook the task of composing the article. Additionally, we extend our special gratitude to Professor Hu Chunyun for his guidance on this paper. All authors granted their approval for the final iteration of the study. Corresponding author Ethics declarations Conflict of interest All authors affirm the absence of any conflict of interest. Ethics statement An ethics statement was not required for this study type as it is based exclusively on data from published literature. 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