Robotic-assisted laparoscopy is a feasible method for resection of deep infiltrating endometriosis, especially in the rectosigmoid area
Open accessAbstract
Objective: This study aimed to compare outcomes of mini-invasive surgical treatment of endometriosis, especially conventional laparoscopy with robotic-assisted laparoscopy, and to evaluate the quality of life. Methods: One hundred three consecutive patients with endometriosis who had surgery from 2014 to 2017 owing to an indication of pain were enrolled in this retrospective study. The majority (n = 77, 75%) of patients underwent conventional laparoscopy and 18 (17%) had robotic-assisted laparoscopy. The quality of life was postoperatively assessed with a questionnaire. Results: The rates of parametrectomy (76% vs. 45%,) and rectovaginal resection (28% vs. 4%) were significantly higher in robotic-assisted laparoscopy than in laparoscopy. Additionally, the rate of bowel operations (50% vs. 17%), especially the shaving technique, was higher in robotic-assisted laparoscopy surgery than in laparoscopy (39% vs. 8%). There was no difference in the rate of postoperative complications between laparoscopy and robotic-assisted laparoscopy. Most (91%) of the patients who answered the questionnaire felt that surgical treatment had relieved their pain. In the laparoscopic and robotic-assisted groups, 88% of respondents felt that their quality of life had improved after surgery. Conclusions: This study suggests that robotic-assisted laparoscopy is a feasible method to resect deep infiltrating endometriosis, especially in the rectosigmoid area.
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Written from the paper’s full text.
TL;DR
In a retrospective single-center series of 103 patients with painful endometriosis, robotic-assisted laparoscopy was used for more extensive resection of deep infiltrating endometriosis than conventional laparoscopy, especially in the rectosigmoid area. Postoperative complications did not differ between approaches, and most questionnaire respondents reported pain relief and improved quality of life.
Key findings
- Robotic-assisted laparoscopy had significantly higher rates than conventional laparoscopy of parametrectomy (76% vs 45%, p = 0.036), rectovaginal resection (28% vs 4%, p = 0.001), bowel operations (50% vs 17%, p = 0.011), and shaving (39% vs 8%, p = 0.011).
- There was no significant difference in postoperative complications between conventional laparoscopy and robotic-assisted laparoscopy; the most common complications were urinary and genital infections, prolonged pain, and short-term dysuria.
- Among questionnaire respondents, 91% felt surgical treatment had relieved their pain, and 88% in both the laparoscopic and robotic-assisted groups felt their quality of life had improved after surgery.
- Mean NRS pain scores after surgery were 1.9 ± 1.2 at 1 year, 1.0 ± 0.8 at 2 years, 3.1 ± 1.0 at 3 years, 1.7 ± 1 at 4 years, and 3.6 ± 0.8 at 5 years, with no significant changes between time points or between laparoscopic and robotic-assisted surgery.
Methods
- Retrospective study of 103 consecutive patients operated for endometriosis-related pain between January 2014 and December 2017 at Kuopio University Hospital; 76/77 underwent conventional laparoscopy and 18 underwent robotic-assisted laparoscopy.
- Data were collected from medical files, including symptoms, biomarkers, MRI, operative details, and Clavien–Dindo complications; a non-validated well-being questionnaire was sent in January 2019, with 45 patients (44%) responding.
- Statistical analysis used IBM SPSS version 27, with Kruskal–Wallis and Mann–Whitney tests for continuous variables, chi-square tests for frequency tables, and p < 0.05 considered significant.
Limitations
- The paper states that the study was retrospective with a limited number of patients, that more complex cases were routinely operated on using robotic-assisted techniques after 2016 and thus had shorter follow-up, that the questionnaire was not validated, that there was no preoperative quality-of-life information, and that pain was the only symptom evaluated.
- Evident from the text: the robotic-assisted group was small (n = 18), the questionnaire response rate was only 44%, and treatment allocation was not randomized, so selection bias likely affects comparisons between surgical approaches.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
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Claims the paper makes
0 of 2 cited sources checked · 0 supported · 0 flagged
- Findingown data
The shaving technique was applied significantly more frequently in robotic-assisted laparoscopy than in conventional laparoscopy (39% vs 8%, p = 0.011).
“Additionally, the rate of bowel operations (50% vs. 17%), especially the shaving technique, was higher in robotic-assisted laparoscopy surgery than in laparoscopy (39% vs. 8%).”
- Also stated in: § Surgical techniques · plain
“In particular, the shaving technique was applied more frequently in robotic-assisted laparoscopy than in conventional laparoscopy (p = 0.011) (Figure 1).”
- Also stated in: § Surgical techniques · plain
“Shaving | 6 (8) | 7 (39) | 0.011”
Quote in the paperNot a substantial claim - Also stated in: § Surgical techniques · plain
- Findingown data
The rate of bowel operations was significantly higher in robotic-assisted laparoscopy than in conventional laparoscopy (50% vs 17%, p = 0.011).
“Additionally, the rate of bowel operations (50% vs. 17%), especially the shaving technique, was higher in robotic-assisted laparoscopy surgery than in laparoscopy (39% vs. 8%).”
- Also stated in: § Surgical techniques · plain
“Additionally, significantly more bowel operations were performed in robotic-assisted laparoscopy than in conventional laparoscopy (p = 0.011).”
- Also stated in: § Surgical techniques · plain
“Bowel operations | 13 (17) | 9 (50) | 0.011”
Quote in the paperNot a substantial claim - Also stated in: § Surgical techniques · plain
- Findingown data
The rate of parametrectomy was significantly higher in robotic-assisted laparoscopy than in conventional laparoscopy (76% vs 45%, p = 0.036).
“The rates of parametrectomy (76% vs. 45%,) and rectovaginal resection (28% vs. 4%) were significantly higher in robotic-assisted laparoscopy than in laparoscopy.”
- Also stated in: § Surgical techniques · plain
“significantly higher rates of parametrectomy (p = 0.036) and rectovaginal resections (p = 0.001) were performed in robotic-assisted laparoscopy than in conventional laparoscopy.”
- Also stated in: § Surgical techniques · plain
“Parametrectomy (e.g., sacral ligament) | 34 (45) | 13 (76) | 0.036”
Quote in the paperNot a substantial claim - Also stated in: § Surgical techniques · plain
- Findingown data
No conversions to laparotomy were undertaken in the study.
“No conversions to laparotomy were undertaken.”
- Also stated in: § Discussion · plain
“In the current study, no conversions to laparotomy were performed, which suggested the feasibility of using robotics.”
Quote in the paperSubstantial claim - Also stated in: § Discussion · plain
- Findingown data
Most (91%) of the questionnaire respondents felt that surgical treatment had relieved their pain.
“Most (91%) of the patients who answered the questionnaire felt that surgical treatment had relieved their pain.”
- Also stated in: § Postoperative questionnaire of well-being · plain
“Most (91%) of the respondents felt that surgical treatment had relieved their pain and 90% of the respondents thought that the operation had been beneficial.”
Quote in the paperNot a substantial claim - Also stated in: § Postoperative questionnaire of well-being · plain
- Findingown data
The rate of rectovaginal resection was significantly higher in robotic-assisted laparoscopy than in conventional laparoscopy (28% vs 4%, p = 0.001).
“The rates of parametrectomy (76% vs. 45%,) and rectovaginal resection (28% vs. 4%) were significantly higher in robotic-assisted laparoscopy than in laparoscopy.”
- Also stated in: § Surgical techniques · plain
“significantly higher rates of parametrectomy (p = 0.036) and rectovaginal resections (p = 0.001) were performed in robotic-assisted laparoscopy than in conventional laparoscopy.”
- Also stated in: § Surgical techniques · plain
“Rectovaginal resection | 3 (4) | 5 (28) | 0.001”
Quote in the paperSubstantial claim - Also stated in: § Surgical techniques · plain
- Findingown data
There was no significant difference in the rate of postoperative complications between conventional laparoscopy and robotic-assisted laparoscopy.
“There was no difference in the rate of postoperative complications between laparoscopy and robotic-assisted laparoscopy.”
- Also stated in: § Complications · plain
“There were no significant differences in the rates of postoperative complications between conventional laparoscopy and robotic-assisted laparoscopy (Table 2).”
- Also stated in: § Discussion · plain
“In our study, there was no difference in the rate of complications between patients who had robotic-assisted laparoscopy or conventional laparoscopy.”
Quote in the paperSubstantial claim - Also stated in: § Complications · plain
- Findingown data
In the laparoscopic and robotic-assisted groups, 88% of respondents felt that their quality of life had improved after surgery.
“In the laparoscopic and robotic-assisted groups, 88% of respondents felt that their quality of life had improved after surgery.”
- Also stated in: § Postoperative questionnaire of well-being · plain
“In the laparoscopic and robotic-assisted groups, 88% of the respondents felt that their quality of life had improved after surgery.”
Quote in the paperNot a substantial claim - Also stated in: § Postoperative questionnaire of well-being · plain
- Findingown data
90% of the questionnaire respondents thought that the operation had been beneficial.
“Most (91%) of the respondents felt that surgical treatment had relieved their pain and 90% of the respondents thought that the operation had been beneficial.”
Quote in the paperNot a substantial claim - Interpretationown data
Robotic-assisted laparoscopy is a feasible method to resect deep infiltrating endometriosis, especially in the rectosigmoid area.
“This study suggests that robotic-assisted laparoscopy is a feasible method to resect deep infiltrating endometriosis, especially in the rectosigmoid area.”
- Also stated in: § Discussion · plain
“We found that robotic-assisted laparoscopy was a feasible method for resection of DIE, especially in the rectosigmoid area.”
- Also stated in: § Discussion · hedged
“In conclusion, the present study suggests that robotic-assisted laparoscopy is a feasible method to resect DIE.”
Quote in the paperSubstantial claim - Also stated in: § Discussion · plain
- Interpretationown data
Mini-invasive surgical treatment improves the quality of life in the majority of patients suffering from endometriosis-related pain.
“Mini-invasive surgical treatment also improves the quality of life in the majority of patients suffering from endometriosis-related pain.”
- Also stated in: § Discussion · plain
“Most of the responders reported that surgery relieved their endometriosis-related pain and their quality of life had improved.”
Quote in the paperSubstantial claim- Rests on an assumption: The well-being questionnaire accurately measures postoperative pain relief and quality of life.
- Rests on an assumption: The patients who returned the questionnaire are representative of the entire surgical cohort with respect to pain relief and quality of life.
- Also stated in: § Discussion · plain
- May combine two claims. 6
- Classified as probably not a substantial claim. 9
May combine two claims.
Findingown dataThere were no significant changes in NRS values between time points or between laparoscopic or robotic-assisted surgery.
“There were no significant changes in NRS values between time points or between laparoscopic or robotic-assisted surgery.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataTwo-thirds (62%) of respondents who had laparoscopy and one-third of respondents who had robotic-assisted laparoscopy reported still experiencing endometriosis-related pain less or more often than monthly.
“Two-thirds (62%) of the respondents who had laparoscopy and one-third of respondents who had robotic-assisted laparoscopy reported that they were still experiencing pain due to endometriosis less or more often than monthly.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationThe stage of endometriosis was classified in accordance with the revised American Society for Reproductive Medicine classification.
“The stage of endometriosis was classified in accordance with revised American Society for Reproductive Medicine classification.18”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [18] Haas D Shebl O Shamiyeh A, et al. The rASRM score and the Enzian classification for endometriosis: their strengths and weaknesses. Acta Obstet Gynecol Scand 2013; 92: 3– 7. 23061819 source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataThe study had no information on quality of life before surgery.
“Third, we had no information on the quality of life before the patients had surgery.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductreasoningThere might have been bias because more complex cases were routinely operated on using robotic-assisted techniques after 2016, and these patients had shorter follow-up.
“There might have been some bias because the more complex cases were routinely operated on using robotic-assisted techniques after 2016. These patients had a shorter follow-up time than patients who were operated on before this time.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe questionnaire of well-being has not been validated.
“Second, our questionnaire of well-being has not been validated.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductown dataThe study was retrospective and the number of patients was limited.
“First, our study was retrospective and the number of patients was limited.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenThe Research Ethical Committee of Northern Savo approved the study protocol and written informed consent was obtained from all patients.
“The Research Ethical Committee of Northern Savo approved the study protocol (1012/13.02.00/2018) and written informed consent was obtained from all patients.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataThe numeric rating scale (NRS) from 0 to 10 was used to assess pain.
“The numeric rating scale (NRS) from 0 to 10 was used, where 0 indicates no pain and 10 the worst possible pain.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenPain was the only symptom evaluated.
“Furthermore, pain was the only symptom that we evaluated.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationThe Clavien-Dindo classification was used for postoperative complications.
“Clavien–Dindo classification,19”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [19] Clavien PA Barkun J De Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009; 250: 187– 196. 19638912 source
Not checked in the free run.
Classified as probably not a substantial claim.
Study design and conductnone givenEndometriosis was diagnosed by laparoscopy or histologically in all patients.
“Endometriosis was diagnosed by laparoscopy or histologically in all patients.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataAlmost half (44%, n = 45) of the patients returned the well-being questionnaire.
“Almost half (44%, n = 45) of the patients returned the well-being questionnaire, which was sent to them after the operation.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductnone givenThe first 2 years of follow-up included patients who had undergone either robotic-assisted or laparoscopic surgery, but later evaluation included only conventional laparoscopic operations.
“Notably, in this study, the first 2 years of follow-up included patients who had undergone either robotic-assisted or laparoscopic surgery, but the later evaluation included only those who had been treated with conventional laparoscopic operations.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
The well-being questionnaire accurately measures postoperative pain relief and quality of life.
“The quality of life was postoperatively assessed with a questionnaire.”
“Second, our questionnaire of well-being has not been validated.”
The paper relies on this without support.
The patients who returned the questionnaire are representative of the entire surgical cohort with respect to pain relief and quality of life.
“Almost half (44%, n = 45) of the patients returned the well-being questionnaire, which was sent to them after the operation.”
“Most (91%) of the respondents felt that surgical treatment had relieved their pain and 90% of the respondents thought that the operation had been beneficial.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Robot-assisted laparoscopy is a possible method of DIE resection.
“The latest study suggests that robot-assisted laparoscopy is a possible method of DIE resection [134].”
From Endometriosis: Epidemiology, Classification, Pathogenesis, Treatment and Genetics (Review of Literature) (2021) · cites this paper as [134]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Robotic unilateral adnexectomy percentage is incorrect
MinorOne patient among the 18 in the robotic group represents approximately 6%, not 1%.
Reported 1 · recomputed 5.555556
“| Unilateral | 17 (22) | 1 (1) | |”
Table 1 laparoscopy percentage is incorrect
MinorTable 1 reports 76 of 103 patients as 75%; that fraction is approximately 74%.
Reported 75 · recomputed 73.786408
“| Laparoscopy | 76 (75) |”
Robotic bladder resection percentage is incorrect
MinorOne bladder resection among 18 robotic patients represents approximately 6%, not 1%.
Reported 1 · recomputed 5.555556
“| Bladder resection | 1 (1) | 1 (1) | ns |”
Conventional laparoscopy count differs between abstract and table
MinorThe abstract reports 77 patients who underwent conventional laparoscopy, while Table 1 reports 76.
“The majority (n = 77, 75%) of patients underwent conventional laparoscopy and 18 (17%) had robotic-assisted laparoscopy.”
“| Laparoscopy | 76 (75) |”
Laparoscopic endometrioma resection percentage is incorrect
MinorTable 2 lists 36 resections among 76 laparoscopic patients, which is approximately 47%, not 41%.
Reported 41 · recomputed 47.368421
“| Endometrioma resection | 36 (41) | 9 (50) | ns |”
Robotic retrocervical resection percentage is incorrect
MinorEleven of 18 robotic patients represent approximately 61%, rather than the reported 65%.
Reported 65 · recomputed 61.111111
“| Retrocervical resection | 35 (46) | 11 (65) | ns |”
Cites
The Clavien-Dindo Classification of Surgical Complications: Five-Year Experience
Clavien, P. A., Barkun, J., de Oliveira, M. L., Vauthey, J. N., Dindo, D., Schulick, R. D., de Santibañes, E., Pekolj, J., Slankamenac, K., Bassi, C., et al. (2009) · Annals of Surgery · doi:10.1097/sla.0b013e3181b13ca2 · Cited by 11,482 · see citing works
Rethinking mechanisms, diagnosis and management of endometriosis
Chapron, C., Marcellin, L., Borghese, B., & Santulli, P. (2019) · Nature Reviews Endocrinology · doi:10.1038/s41574-019-0245-z · Cited by 1,084 · cited 1× · see citing works
“Pharmacological treatments are the standard treatment for endometriosis.(2,3) However, when deep infiltrating endometriosis (DIE) decreases the quality of life because of associated pain or due to dysfunction of the bowels, bladder or ovaries, then surgical treatment is necessary.”
BackgroundEndometriosis and infertility: pathophysiology and management
de Ziegler, D., Borghese, B., & Chapron, C. (2010) · The Lancet · doi:10.1016/s0140-6736(10)60490-4 · Cited by 836 · cited 1× · see citing works
“Approximately 50% to 80% of patients with endometriosis consider a surgical treatment to be beneficial for endometriosis-related pain during the first 2 years after the operation.(31,32) However, after 2 to 5 years, 36% of surgically treated patients might need to undergo a new operation(33) These results are in line…”
ResultClinical Management of Endometriosis
Falcone, T., & Flyckt, R. L. (2018) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000002469 · Cited by 582 · see citing works
Bazot, M., Lafont, C., Rouzier, R., Roseau, G., Thomassin-Naggara, I., & Daraï, E. (2009) · Fertility and Sterility · doi:10.1016/j.fertnstert.2008.09.005 · Cited by 434 · cited 6× · see citing works
“According to the European Society of Urogenital Radiology, MRI is recommended as a second-line imaging technique preoperatively.20 Transvaginal ultrasound and MRI achieve a similar accuracy in the diagnosis of DIE.21 Currently, MRI imaging is a routine procedure before surgery to evaluate the location and extent of DI…”
MethodInfluentialAbbott, J. A. (2003) · Human Reproduction · doi:10.1093/humrep/deg275 · Cited by 403 · see citing works
Treatment of pelvic pain associated with endometriosis: a committee opinion
(2014) · Fertility and Sterility · doi:10.1016/j.fertnstert.2014.02.012 · Cited by 397 · see citing works
European society of urogenital radiology (ESUR) guidelines: MR imaging of pelvic endometriosis
Bazot, M., Bharwani, N., Huchon, C., Kinkel, K., Cunha, T. M., Guerra, A., Manganaro, L., Buñesch, L., Kido, A., Togashi, K., et al. (2016) · European Radiology · doi:10.1007/s00330-016-4673-z · Cited by 345 · cited 1× · see citing works
“According to the European Society of Urogenital Radiology, MRI is recommended as a second-line imaging technique preoperatively.(20) Transvaginal ultrasound and MRI achieve a similar accuracy in the diagnosis of DIE.”
MethodKondo, W., Bourdel, N., Tamburro, S., Cavoli, D., Jardon, K., Rabischong, B., Botchorishvili, R., Pouly, J., Mage, G., & Canis, M. (2011) · BJOG: An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.2010.02774.x · Cited by 208 · see citing works
Bowel endometriosis: Diagnosis and management
Nezhat, C., Li, A., Falik, R., Copeland, D., Razavi, G., Shakib, A., Mihailide, C., Bamford, H., DiFrancesco, L., Tazuke, S., et al. (2018) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2017.09.023 · Cited by 205 · cited 2× · see citing works
“However, discoid excision or segmental resection is still an option to treat DIE at or above the sigmoid colon.(23) In our study, we preferred shaving in accordance with recommendations.”
BackgroundMethodThe rASRM score and the Enzian classification for endometriosis: their strengths and weaknesses
HAAS, D., SHEBL, O., SHAMIYEH, A., & OPPELT, P. (2013) · Acta Obstetricia et Gynecologica Scandinavica · doi:10.1111/aogs.12026 · Cited by 204 · cited 1× · see citing works
“The stage of endometriosis was classified in accordance with revised American Society for Reproductive Medicine classification.(18) Briefly, the stage of endometriosis is divided into the four stages of I (minimal), II (mild), III (moderate) and IV (severe).”
MethodLaparoscopic colorectal resection for deep infiltrating endometriosis: analysis of 436 cases
Ruffo, G., Scopelliti, F., Scioscia, M., Ceccaroni, M., Mainardi, P., & Minelli, L. (2010) · Surgical Endoscopy · doi:10.1007/s00464-009-0517-0 · Cited by 156 · cited 1× · see citing works
“Currently, even extensive radical operations of the bowels or urinary tract can be performed mini-invasively.(9,10) A few studies compared laparoscopic or robotic-assisted approaches in the surgical management of endometriosis.”
BackgroundAbo, C., Moatassim, S., Marty, N., Saint Ghislain, M., Huet, E., Bridoux, V., Tuech, J. J., & Roman, H. (2018) · Fertility and Sterility · doi:10.1016/j.fertnstert.2017.10.001 · Cited by 143 · cited 1× · see citing works
“The management of bowel endometriosis depends on the number of lesions, and their depth of invasion, size and circumferential involvement.(17,26) Therefore, selection of the surgical technique needs to be tailored to each individual patient.”
BackgroundImpact of endometriosis on quality of life and psychological well-being
Vitale, S. G., Rosa, V. L. L., Rapisarda, A. M. C., & Laganà, A. S. (2016) · Journal of Psychosomatic Obstetrics & Gynecology · doi:10.1080/0167482x.2016.1244185 · Cited by 142 · cited 1× · see citing works
“Although endometriosis is considered as a benign disease, it can cause severe chronic pain and infertility, and decrease the quality of life.(1) Pharmacological treatments are the standard treatment for endometriosis.”
BackgroundSoto, E., Luu, T. H., Liu, X., Magrina, J. F., Wasson, M. N., Einarsson, J. I., Cohen, S. L., & Falcone, T. (2017) · Fertility and Sterility · doi:10.1016/j.fertnstert.2016.12.033 · Cited by 137 · cited 2× · see citing works
“The LAROSE trial, which was a randomized, multicenter trial, compared the treatment of endometriosis between robotic-assisted laparoscopy and conventional laparoscopy.(11) This trial was not able to detect any differences in perioperative outcomes or the operative time between the robotic-assisted procedure and laparo…”
MethodResultRobotic versus standard laparoscopy for the treatment of endometriosis
NEZHAT, C. R., Lewis, M. L., Kotikela, S., Veeraswamy, A., Saadat, L. V., Hajhosseini, B., & Nezhat, C. (2010) · Fertility and Sterility · doi:10.1016/j.fertnstert.2010.04.031 · Cited by 135 · cited 1× · see citing works
“Some of these studies reported longer operation times with roboticassisted procedures than with laparoscopy, while other studies found benefits from robotic-assisted surgery.(12,14,16) Ercoli et al.”
ResultRoman, H., Vassilieff, M., Tuech, J. J., Huet, E., Savoye, G., Marpeau, L., & Puscasiu, L. (2013) · Fertility and Sterility · doi:10.1016/j.fertnstert.2013.01.131 · Cited by 106 · see citing works
Long-term functional outcomes following colorectal resection versus shaving for rectal endometriosis
Roman, H., Milles, M., Vassilieff, M., Resch, B., Tuech, J.-J., Huet, E., Darwish, B., & Abo, C. (2016) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2016.06.055 · Cited by 101 · cited 1× · see citing works
“Especially at the level of the low rectum, shaving is the recommended method to avoid injury of vascular and sympathetic and parasympathetic nerve bundles.(7,24,25) However, discoid excision or segmental resection is still an option to treat DIE at or above the sigmoid colon.”
MethodRoman, H., Moatassim, S., Marty, N., Milles, M., Vallée, A., Desnyder, E., Loi, E. S., & Abo, C. (2016) · Fertility and Sterility · doi:10.1016/j.fertnstert.2016.07.1097 · Cited by 88 · cited 1× · see citing works
“Especially at the level of the low rectum, shaving is the recommended method to avoid injury of vascular and sympathetic and parasympathetic nerve bundles.(7,24,25) However, discoid excision or segmental resection is still an option to treat DIE at or above the sigmoid colon.”
MethodBosev, D., Nicoll, L. M., Bhagan, L., Lemyre, M., Payne, C. K., Gill, H. S., & NEZHAT, C. R. (2009) · The Journal of Urology · doi:10.1016/j.juro.2009.08.019 · Cited by 87 · cited 1× · see citing works
“Currently, even extensive radical operations of the bowels or urinary tract can be performed mini-invasively.(9,10) A few studies compared laparoscopic or robotic-assisted approaches in the surgical management of endometriosis.”
BackgroundRestaino, S., Mereu, L., Finelli, A., Spina, M. R., Marini, G. M. F., Catena, U., Turco, L. C., Moroni, R., Milani, M., Cela, V., et al. (2020) · Journal of Robotic Surgery · doi:10.1007/s11701-020-01061-y · Cited by 77 · see citing works
Surgical Excision of Advanced Endometriosis: Perioperative Outcomes and Impacting Factors
Magrina, J. F., Espada, M., Kho, R. M., Cetta, R., Chang, Y.-H. H., & Magtibay, P. M. (2015) · Journal of Minimally Invasive Gynecology · doi:10.1016/j.jmig.2015.04.016 · Cited by 65 · cited 1× · see citing works
“Some of these studies reported longer operation times with roboticassisted procedures than with laparoscopy, while other studies found benefits from robotic-assisted surgery.(12,14,16) Ercoli et al.”
ResultNezhat, F. R., & Sirota, I. (2014) · JSLS Journal of the Society of Laparoscopic & Robotic Surgeons · doi:10.4293/jsls.2014.00094 · Cited by 62 · cited 2× · see citing works
“Some of these studies reported longer operation times with roboticassisted procedures than with laparoscopy, while other studies found benefits from robotic-assisted surgery.(12,14,16) Ercoli et al.”
ResultMabrouk, M., Raimondo, D., Altieri, M., Arena, A., Del Forno, S., Moro, E., Mattioli, G., Iodice, R., & Seracchioli, R. (2019) · Journal of Minimally Invasive Gynecology · doi:10.1016/j.jmig.2018.08.031 · Cited by 54 · cited 1× · see citing works
“, the overall rate of short-term postoperative complications was significantly higher in patients who underwent segmental resection compared with those who underwent discoid excision or shaving.(8) Furthermore, segmental resection does not appear to achieve more long-lasting improvement of symptoms compared with disco…”
BackgroundSpagnolo, E., Zannoni, L., Raimondo, D., Ferrini, G., Mabrouk, M., Benfenati, A., Villa, G., Bertoldo, V., & Seracchioli, R. (2014) · Journal of Minimally Invasive Gynecology · doi:10.1016/j.jmig.2014.05.012 · Cited by 48 · see citing works
Vizzielli, G., Cosentino, F., Raimondo, D., Turco, L. C., Vargiu, V., Iodice, R., Mastronardi, M., Mabrouk, M., Scambia, G., & Seracchioli, R. (2020) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1111/aogs.13866 · Cited by 48 · cited 1× · see citing works
“However, intraoperative near-infrared radiation imaging can be used during conventional or roboticassisted laparoscopy.(29) In our study, there was no difference in the rate of complications between patients who had robotic-assisted laparoscopy or conventional laparoscopy.”
Combined Oral Contraceptive Therapy in Women with Posterior Deep Infiltrating Endometriosis
Mabrouk, M., Frascà, C., Geraci, E., Montanari, G., Ferrini, G., Raimondo, D., Alvisi, S., Paradisi, R., Villa, G., & Seracchioli, R. (2011) · Journal of Minimally Invasive Gynecology · doi:10.1016/j.jmig.2011.04.008 · Cited by 46 · cited 1× · see citing works
“Pharmacological treatments are the standard treatment for endometriosis.(2,3) However, when deep infiltrating endometriosis (DIE) decreases the quality of life because of associated pain or due to dysfunction of the bowels, bladder or ovaries, then surgical treatment is necessary.”
BackgroundSeracchioli, R., Raimondo, D., Arena, A., et al. (2018) · Fertility and Sterility · doi:10.1016/j.fertnstert.2018.02.122 · Cited by 46 · cited 1× · see citing works
“Recently, intravenous indocyanine green and near-infrared radiation imaging were reported to have an additional benefit in rectosigmoid endometriosis in assessing the blood supply of the bowel after resection.(28) These techniques might also be helpful in separating endometrial nodules from healthy tissue.”
BackgroundErcoli, A., Bassi, E., Ferrari, S., Surico, D., Fagotti, A., Fanfani, F., De Cicco, F., Surico, N., & Scambia, G. (2017) · Journal of Minimally Invasive Gynecology · doi:10.1016/j.jmig.2017.03.011 · Cited by 32 · cited 6× · see citing works
“showed that robotic-assisted laparoscopic nerve-sparing rectal nodulectomy appeared to be a feasible and safe approach in treating isolated retrocervical–rectal DIE.(27) Recently, intravenous indocyanine green and near-infrared radiation imaging were reported to have an additional benefit in rectosigmoid endometriosis…”
BackgroundInfluentialGac, M. L., Ferrier, C., Touboul, C., Owen, C., Arfi, A., Boudy, A., Jayot, A., Bendifallah, S., & Daraï, É. (2020) · Journal of Gynecology Obstetrics and Human Reproduction · doi:10.1016/j.jogoh.2020.101885 · Cited by 30 · cited 1× · see citing works
“Our results are also in line with a recent pilot study that compared robotic-assisted and conventional laparoscopy in treating colorectal endometriosis.(30) In our cohort, all of the laparotomies were performed when robotic-assisted surgeries were not available in our institution.”
ResultDulemba, J. F., Pelzel, C., & Hubert, H. B. (2012) · Journal of Robotic Surgery · doi:10.1007/s11701-012-0361-4 · Cited by 27 · cited 1× · see citing works
“Our patients represent a typical cohort of those who have endometriosis-related pain.(13) Pelvic pain, dyspareunia and dyschezia were the most common symptoms in our patients.”
BackgroundRobotic treatment of bowel endometriosis
Hur, C., & Falcone, T. (2021) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2020.05.012 · Cited by 25 · cited 2× · see citing works
“The management of bowel endometriosis depends on the number of lesions, and their depth of invasion, size and circumferential involvement.(17,26) Therefore, selection of the surgical technique needs to be tailored to each individual patient.”
BackgroundNEZHAT, C. R., & Schipper (2012) · International Journal of Women s Health · doi:10.2147/ijwh.s24948 · Cited by 24 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- Schipper E, 2012, Int J Womens Health, 4, 383
Cited by
Sorted by citations
Smolarz, B., Szyłło, K., & Romanowicz, H. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms221910554 · Cited by 560 · see citing works
Pavone, M., Baroni, A., Campolo, F., Goglia, M., Raimondo, D., Carcagnì, A., Akladios, C. Y., Marescaux, J., Fanfani, F., Scambia, G., et al. (2024) · Journal of Robotic Surgery · doi:10.1007/s11701-024-01954-2 · Cited by 44 · see citing works
Csirzó, Á., Kovács, D. P., Szabó, A., Fehérvári, P., Jankó, Á., Hegyi, P., Nyírády, P., Sipos, Z., Sára, L., Ács, N., et al. (2023) · Surgical Endoscopy · doi:10.1007/s00464-023-10587-9 · Cited by 30 · see citing works
“This might indicate that the surgeon favored a robotic approach and might have added bias to the results, contributing to differences in operating times [24, 31].”
ResultIs It the Best Option? Robotic Surgery for Endometriosis
Lee, J. H., & Kim, S. (2024) · Life · doi:10.3390/life14080982 · Cited by 10 · see citing works
Radilla, L. A., Yang, Q., Lovell, D. Y., et al. (2025) · Scientific Reports · doi:10.1038/s41598-025-05082-1 · Cited by 7 · see citing works
“Hiltunen et al. provided compelling evidence that this approach is effective for resecting deep infiltrative endometriosis, particularly in cases involving the ureters, and significantly improves patient quality of life by reducing endometriosis-related pain 4 .”
Utkarsh, K., Srivastava, N., Papayannakos, C. J., Nayyar, A., Khan, A. U., & Haque, S. (2023) · Extracellular Vesicles and Circulating Nucleic Acids · doi:10.20517/evcna.2023.43 · Cited by 7 · see citing works
Bandala, C., Cifuentes-Chacón, J. P., Vázquez, A. C., Ruz-Barros, R., Garrocho-Hernández, L., & Algara, A. L. C. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13123576 · Cited by 6 · see citing works
“It has been shown that operative time decreases in relation to the increase in surgeries performed [37], as well as the condition of the patients and the severity of endometriosis [24,26,31], as mentioned before.”
BackgroundMethodInfluentialIanieri, M. M., Raimondo, D., Pavone, M., Alboni, C., Alesi, M. V., Campolo, F., Raffone, A., Celerino, P., Orsini, B., Carcagnì, A., et al. (2024) · Minimally Invasive Therapy & Allied Technologies · doi:10.1080/13645706.2024.2417403 · Cited by 5 · see citing works
“Although surgery led to an improvement in dys-pareunia in both groups, as previously noted by various authors [8,41], we observed a significant difference favoring the Da Vinci system, likely due to initially higher dyspareunia values in the group undergoing surgery with Hugo TM RAS system.”
Xydias, E. M., Tsakos, E., Daniilidis, A., Grigoriadis, G., Gousis, G., Crestani, A., Merlot, B., & Roman, H. (2026) · Minerva Obstetrics and Gynecology · doi:10.23736/s2724-606x.25.05814-2 · Cited by 3 · see citing works
Robotic surgery for bowel endometriosis: a multidisciplinary management of a complex entity
Piozzi, G. N., Burea, V., Duhoky, R., Stefan, S. S., So, C., Wilby, D., Tsepov, D., & Khan, J. S. (2024) · Techniques in Coloproctology · doi:10.1007/s10151-023-02904-0 · Cited by 2 · see citing works
Elhadi, M., Arellano, D. Z., LeFave, J.-P. J., & Haas, E. M. (2026) · Journal of Robotic Surgery · doi:10.1007/s11701-026-03690-1 · Cited by 1 · see citing works
“Previous comparative studies have been limited by small sample sizes, particularly in robotic arms [9, 25 ], or have been non-comparative case series.”
Robotic-assisted laparoscopy in reproductive surgery: what is new?
LONGO, M., Gaia, G., Afonina, M., Alboni, C., & Marca, A. L. (2023) · Gazzetta Medica Italiana Archivio per le Scienze Mediche · doi:10.23736/s0393-3660.22.04959-2
Valent, S., Csirzó, Á., Kovács, D. P., Szabó, A., Fehérvári, P., Jankó, Á., Hegyi, P., Nyírády, P., Sipos, Z., Sára, L., et al. (2023) · doi:10.22541/au.168351487.71384228/v1
Hryhorenko, A. O. (2026) · Medical Science of Ukraine (MSU) · doi:10.32345/2664-4738.2.2026.03
Madar, A., Ferrier, C., Dabi, Y., et al. (2026) · Journal of Minimally Invasive Gynecology · doi:10.1016/j.jmig.2026.07.026
- Authors
- Hiltunen, J., Eloranta, M.-L., Lindgren, A., Keski-Nisula, L., Anttila, M., & Sallinen, H.
- Affiliations
- University of Eastern Finland (FI)
- Kuopio University Hospital (FI)
- Department of Gynecology and Obstetrics, Kuopio University Hospital, Kuopio University Hospital, Kuopio, Finland
- Corresponding author
- Sallinen, Hanna
- Venue
- Journal of International Medical Research
- Publisher
- SAGE Publications
- Published
- 2021-08
- Volume
- 49
- Issue
- 8
- Pages
- 3000605211032788-3000605211032788
- ISSN
- 0300-0605 (ISSN-L)
- 1473-2300
- PMC
- PMC8381426
- OpenAlex
- W3135166270
- Cited by
- 15
- References
- 32
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 5 · 2023: 4 · 2021: 1
- FWCI
- 2.16
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Journal of International Medical Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UEF eRepo (University of Eastern Finland) (submittedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Keywords
- deep infiltrating endometriosis, robot-assisted laparoscopic surgery, conventional laparoscopy, rectosigmoid endometriosis, parametrectomy, postoperative complications, quality of life, chronic pelvic pain, minimally invasive surgery
- MeSH terms
- Endometriosis, Female, Humans, Laparoscopy, Postoperative Complications, Quality of Life, Retrospective Studies, Treatment Outcome, Robotic Surgical Procedures
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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