Laparoscopic surgery is the current gold standard both for diagnosing endometriosis and removing endometriotic lesions.
What is robotic surgery?
Robotic surgery for endometriosis uses a robotic system controlled by a surgeon. The robot here is just a set of instruments consisting of robotic arms, surgical instruments, a monitor, and a console. It does not operate or make decisions on its own. The entire robotic system is always under the control of the surgeon, who sits on a nearby console that shows the target anatomy in high resolution.
What may be some of the benefits of robotic surgery for endometriosis?
Robotic surgery may overcome some of the limitations of manual surgery such as the surgeon not having a three-dimensional vision, reduced degree of freedom, narrow operating field, and lack of anatomical landmarks. It may, therefore, help the surgeon perform smaller incisions with higher precision, allow for a greater range of motion, and provide a high-resolution three-dimensional anatomical view.
However, there has been only one clinical trial (LAROSE) comparing conventional laparoscopy with robotic surgery for the treatment of endometriosis. The study measured operative time as the primary outcome and perioperative complications and quality of life as secondary outcomes.
The results of the study showed an advantage for robotic surgery with respect to operative time. However, there were no differences between the two techniques in terms of blood loss, perioperative complications, or quality of life.
An earlier study that compared the perioperative outcomes in both techniques for advanced-stage endometriosis also showed similar results.
There are currently no studies comparing conventional and robotic surgery with regards to fertility rates following surgery.
What are the drawbacks of robotic surgery for endometriosis?
Robotic surgical equipment does not offer haptic feedback or awareness of position to the surgeon. Robotic manipulation may, therefore, not be precise enough for deep-excision endometriosis surgery. It also requires more abdominal incisions than conventional laparoscopy as robotic surgery traditionally uses four or five port sites.
Another drawback of robotic surgery is that, unlike conventional laparoscopy, the surgeon cannot “feel” characteristics of the disease such as fibrotic scar tissue. This is because the surgeon has to sit away from the patient on a console, which only offers a visual aid with no possibility of physical touch.
Conventional laparoscopy and robotic surgery both have their own advantages and drawbacks. What is important is that they are performed by experts in endometriosis.