Robotic assisted versus laparoscopic surgery for deep endometriosis: a meta-analysis of current evidence

Endometriosis is a benign infammatory onco-mimetic disease afecting 10–15% of women in the world. When it is refractoryto medical treatments, surgery may be required. Usually, laparoscopy is the preferred approach, but robotic surgery has gainedpopularity in the last 15 years. This study aims to evaluate the safety and efcacy of robotic-assisted laparoscopic surgery(RAS) versus conventional laparoscopic surgery (LPS) in the treatment of endometriosis. This study adheres to PRISMAguidelines and is registered with PROSPERO. Studies reporting perioperative data comparing RAS and LPS surgery inpatients with endometriosis querying PubMed, Google Scholar and ClinicalTrials.gov were included in the analysis. TheQuality Assessment of Diagnostic Accuracy Studies 2 tool (QUADAS-2) was used for the quality assessment of the selectedarticles. Fourteen studies were identifed, including 2709 patients with endometriosis stage I-IV for the meta-analysis. Therewere no signifcant diferences between RAS and LPS in terms of intraoperative and postoperative complications, conver-sion rate and estimated blood loss. However, patients in the RAS group have a longer operative time (p<0.0001) and longerhospital stay (p=0.020) than those in the laparoscopic group. Robotic surgery is not inferior to laparoscopy in patients withendometriosis in terms of surgical outcomes; however, RAS requires longer operative times and longer hospital stay. Thebenefts of robotic surgery should be sought in the easiest potential integration of robotic platforms with new technologies.Prospective studies comparing laparoscopy to the new robotic systems are desirable for greater robustness of scientifcevidence.