Robotic surgery vs laparoscopic surgery in patients with diagnosis of endometriosis: a systematic review and meta-analys
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REVIEW ARTICLE
Robotic surgery vs laparoscopic surgery in patients with diagnosis of endometriosis: a systematic review and meta‑analysis Stefano Restaino1,9 · Liliana Mereu2 · Angelo Finelli3 · Maria Roberta Spina3 · Giulia Marini3 · Ursula Catena1 · Luigi Carlo Turco4 · Rossana Moroni5,6 · Michela Milani3 · Vito Cela7 · Giovanni Scambia1,8 · Francesco Fanfani1,8 Received: 18 November 2019 / Accepted: 29 February 2020 © Springer-Verlag London Ltd., part of Springer Nature 2020
Abstract Endometriosis is one of the most common medical conditions affecting the women. The study aimed to evaluate the safety and efficacy of robotic-assisted laparoscopic surgery (RAS) versus conventional laparoscopic surgery (LPS) in the treatment of endometriosis. PubMed, Embase, Cochrane and CINAHL databases were searched from January 1995 to March 2019. According to meta-analysis criteria, five comparative studies were selected. A total of 1527 patients were identified. In the meta-analysis, there were no significant differences in blood loss, complication, and hospital stay between RAS and LPS surgeries in the treatment of patients with endometriosis. However, RAS surgery required a higher weighted mean operating time than LPS surgery, 0.54 (95% confidence interval; 0.37 to 0.70; p 5mm) and often occur in the uterosacral ligaments, pouch of Douglas, vagina, bowel, bladder, and ureter [9, 10]. Treatment recommendations are generally based according to symptoms, response to medical treatment, and fertility status [3]. Many studies agree that surgical resection of DIE improves pain and quality of life [2–4]. There are no specific guidelines from any society regarding the indication and surgical approach for bladder and bowel DIE. The general recommendation by ACOG, ESHRE, and SOGC for the definitive treatment of pain associated with DIE is still hysterectomy with or without bilateral salpingo-oophorectomy in women with no desire for future fertility, associated intractable pelvic pain, adnexal masses, or multiple previous conservative surgical procedures. In women who desire future fertility, conservative surgical treatment sparing the uterus and adnexa should be offered [2–4]. Limited data are available on reproductive outcomes after treatment of DIE [3]. During the last decades, laparoscopic surgery (LPS) has been accepted as the technique of choice for the treatment of endometriosis, because it provides long-term outcomes comparable to those achieved by laparotomy (LPT), with the established advantages of a minimally invasive technique (MIS), including better visualization, shorter hospital stays, faster recovery and better cosmetic results [7]. More recently, robotic-assisted laparoscopic surgery (RAS) has become available [11]. Proponents argue that increased dexterity, depth perception, and wrist articulation compared with conventional laparoscopy may result in improved outcomes for endometriosis [12]. The aim of this review and meta-analysis is to compare RAS versus LPS in the treatment of endometriosis in terms of operative t
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